Paul McArthur Pedersen, LSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149021530 Issued in IL

Practice address

105 E Burlington St
Riverside, IL 60546-2146

Phone

(708) 745-5277

NPI assigned

Oct 10, 2017

Sex

Male

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

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Pillars Community Health

  • Federally Qualified Health Center (FQHC)
  • La Grange Park, IL
  • NPI 1629774039
  NPD (past)

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

{
    "created_epoch": "1507593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722902400000",
    "number": "1609386168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5220 EAST AVE",
            "city": "COUNTRYSIDE",
            "state": "IL",
            "postal_code": "605253133",
            "telephone_number": "708-995-3598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 E BURLINGTON ST",
            "city": "RIVERSIDE",
            "state": "IL",
            "postal_code": "605462146",
            "telephone_number": "708-745-5277"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "321 N La Grange Rd",
            "address_purpose": "LOCATION",
            "city": "LA Grange Park",
            "state": "IL",
            "postal_code": "605265622",
            "country_code": "US",
            "telephone_number": "708-745-5277",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEDERSEN",
        "first_name": "PAUL",
        "middle_name": "MCARTHUR",
        "credential": "LSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-10-10",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149021530",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Frank Rudolph Orland, DDS
• Gina F. Orland, D.M.D.
• Orthomidwest, PLLC
• Orthopaedic Associates of Riverside, PLLC
• Colathur K Palani, M.D.
• Alexandria Perry, PT, DPT
• Play Well Therapy Services Inc
• Garey Potamianos, D.D.S.
• Premier Internal Medicine Group SC
• Themistocles Raftis, PT

• Clinical Social Worker in Riverside, IL
• Providers in Riverside, 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 Aug 6, 2024; 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.