Phyllis Joan Shadwick

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.003288 Issued in IL

Practice address

880 N Lake Shore Dr
#25C
Chicago, IL 60611-1761

Phone

(312) 339-5273

NPI assigned

May 29, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Eaves Health Partners PLLC

  • Clinical Social Worker
  • Skokie, IL
  • NPI 1639847551
  NPD

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

{
    "created_epoch": "1401321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1401321600000",
    "number": "1528470192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "880 N LAKE SHORE DR",
            "address_2": "#25C",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606111761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "880 N LAKE SHORE DR",
            "address_2": "#25C",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606111761",
            "telephone_number": "312-339-5273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHADWICK",
        "first_name": "PHYLLIS",
        "middle_name": "JOAN",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-05-29",
        "last_updated": "2014-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.003288",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hazar Shadid
• Yara Shadid, LSW
• Tevyn Cole Shadlyn, M.D.
• Layla Allison Shadman, PA-C
• Scott Shadrick, PA-C
• Michelle Lynn Martin Shaefer
• Barry Shaeffer, LCSW
• Houri H Shafaie, DDS
• Shafeeq H. Bader, D.D.S., S.C. (Dental Impressions)
• Adam Lloyd Shafer, PSY.D.

• Clinical Social Worker in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.