Individual provider Active NPI

Stephen Kaleb Pollum, LCSW

  • Clinical Social Worker
  • Barrington, IL
National Provider Identifier
1508514894
Registry record updated Apr 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149.026984 Issued in IL
Practice address
111 Lions Dr Ste 210
Barrington, IL 60010-3175
Phone
(888) 428-7890
Fax
(877) 428-7891
NPI assigned
Mar 15, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2024

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 150.106832 IL
Clinical Social Worker 1041C0700X 149.026984 IL Primary

Addresses

Primary practice location

111 Lions Dr Ste 210
Barrington, IL 60010-3175

Mailing address

2687 Little Texas Dr
Humboldt, IL 61931-8046
Phone (217) 273-8829

Other names 1

  • Kaleb Pollum Other name

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
I20240701002563 IL Practitioner - Clinical Social Worker 5294279238 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Edgewood Clinical Services P.C.Group PAC ID 3971963901, 304 clinicians

Practice addresses (Care Compare)

111 Lions Dr
Suite 210
Barrington, IL 60010-3175
Phone (888) 428-7890

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
150.106832ILMDSocial Worker
149.026984ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Edgewood Clinical Services, P.C. Clinical CurrentSince Jun 1, 2024 Accepting new patients
Psychology Specialists LTD Clinical Past Accepting new patients

Locations

111 Lions Dr
Ste 210
Barrington, IL 60010
Phone (847) 304-0044

808 S Eldorado Rd
Ste 102
Bloomington, IL 61704
Phone (309) 212-6007

3027 English Rows Ave
Ste 201
Naperville, IL 60564

2948 Artesian Rd
Ste 112
Naperville, IL 60564
Phone (630) 328-0165

Organizations & group practices 2

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": "1647302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712188800000",
    "number": "1508514894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2687 LITTLE TEXAS DR",
            "city": "HUMBOLDT",
            "state": "IL",
            "postal_code": "619318046",
            "telephone_number": "217-273-8829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 LIONS DR STE 210",
            "city": "BARRINGTON",
            "state": "IL",
            "postal_code": "600103175",
            "telephone_number": "888-428-7890",
            "fax_number": "877-428-7891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLLUM",
        "first_name": "STEPHEN",
        "middle_name": "KALEB",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-15",
        "last_updated": "2024-04-04",
        "certification_date": "2024-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IL",
            "license": "150.106832",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.026984",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KALEB",
            "last_name": "POLLUM",
            "credential": "LCSW",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Barrington, IL

Sources for this page

Verify at the official NPI Registry.