Individual provider Active NPI

Teresa Smith, LCSW

  • Clinical Social Worker
  • Oak Park, IL
National Provider Identifier
1609394212
Registry record updated May 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149.019554 Issued in IL
Practice address
1100 Lake St Ste 230
Oak Park, IL 60301-1095
Phone
(630) 646-7047
NPI assigned
Sep 4, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 149.019554 IL Primary

Addresses

Primary practice location

1100 Lake St Ste 230
Oak Park, IL 60301-1095

Mailing address

229 S Linden Ave
Elmhurst, IL 60126-3606
Phone (708) 351-6108

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
I20220829003531 IL Practitioner - Clinical Social Worker 9537543202 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Endeavor Health Medical GroupGroup PAC ID 2163334699, 3,330 clinicians

Practice addresses (Care Compare)

1100 Lake St
Suite 230
Oak Park, IL 60301-1095
Phone (331) 221-9001

2650 Ridge Ave
Evanston, IL 60201-1700

Merit-based Incentive Payment System (MIPS)

Final score
84.9 of 100Reported as group
Quality
75.91
Promoting interoperability
99
Improvement activities
40
Cost
74.6

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149.019554ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Edward Health Ventures CurrentSince Jul 11, 2022 Accepting new patients
Endeavor Health Medical Group CurrentSince Apr 2, 2024 Accepting new patients
Edward Health Ventures CurrentSince Jul 11, 2022 Accepting new patients
Endeavor Health Medical Group CurrentSince Apr 2, 2024 Accepting new patients

Locations

9532 Eagle Way
Chicago, IL 60678

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206

2650 Ridge Ave
Ste 1223
Evanston, IL 60201
Phone (847) 982-3175

120 Spalding Dr
Ste 310
Naperville, IL 60540
Phone (630) 527-5575

1100 Lake St
Ste 230
Oak Park, IL 60301
Phone (331) 221-9244

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": "1504483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714608000000",
    "number": "1609394212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "229 S LINDEN AVE",
            "city": "ELMHURST",
            "state": "IL",
            "postal_code": "601263606",
            "telephone_number": "708-351-6108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 LAKE ST STE 230",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603011095",
            "telephone_number": "630-646-7047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "TERESA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-04",
        "last_updated": "2024-05-02",
        "certification_date": "2024-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.019554",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Park, IL

Sources for this page

Verify at the official NPI Registry.