Individual provider Active NPI

Deborah N Dyslin Kman

  • Clinical Social Worker
  • Chicago, IL
National Provider Identifier
1497368922
Registry record updated Feb 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149022450 Issued in IL
Practice address
676 N Saint Clair St Ste 1310
Chicago, IL 60611-2923
Phone
(312) 695-9627
Fax
(312) 695-6072
NPI assigned
Aug 25, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 149022450 IL
Clinical Social Worker 1041C0700X 149022450 IL Primary

Addresses

Primary practice location

676 N Saint Clair St Ste 1310
Chicago, IL 60611-2923

Mailing address

676 N Saint Clair St Ste 1310
Chicago, IL 60611-2923
Phone (312) 695-9627

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200929003326 IL Practitioner - Clinical Social Worker 9638598311 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Central Dupage Physician GroupGroup PAC ID 5890696231, 1,087 clinicians

Practice addresses (Care Compare)

25 N Winfield Rd
Winfield, IL 60190-1295
Phone (630) 933-6745

Merit-based Incentive Payment System (MIPS)

Final score
95.63 of 100Reported as apm
Quality
88.47
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149022450ILMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince Sep 11, 2020 Accepting new patients
Central Dupage Physician Group CurrentSince Aug 1, 2022 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Sep 11, 2020 Accepting new patients
Central Dupage Physician Group CurrentSince Aug 1, 2022 Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

676 N Saint Clair St
Fl 9
Chicago, IL 60611

676 N Saint Clair St
Ste 1310
Chicago, IL 60611
Phone (312) 695-9627

676 N Saint Clair St
Ste 945
Chicago, IL 60611
Phone (312) 695-7902

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

1800 N Main St
Wheaton, IL 60187
Phone (630) 469-0045

25 N Winfield Rd
Ste 410
Winfield, IL 60190
Phone (630) 665-2101

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1598313600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644883200000",
    "number": "1497368922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "676 N SAINT CLAIR ST STE 1310",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112923",
            "telephone_number": "312-695-9627",
            "fax_number": "312-695-6072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "676 N SAINT CLAIR ST STE 1310",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112923",
            "telephone_number": "312-695-9627",
            "fax_number": "312-695-6072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DYSLIN KMAN",
        "first_name": "DEBORAH",
        "middle_name": "N",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-25",
        "last_updated": "2022-02-15",
        "certification_date": "2022-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IL",
            "license": "149022450",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149022450",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.