John Patrick Smith-Moore, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.019742 Issued in IL

Practice address

5340 N Clark St Ste 212
Chicago, IL 60640-2120

Phone

(312) 379-9476

NPI assigned

Sep 1, 2020

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

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Oct 2, 2024 through Oct 2, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1598918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694390400000",
    "number": "1609480243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5340 N CLARK ST STE 212",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606402120",
            "telephone_number": "312-379-9476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5340 N CLARK ST STE 212",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606402120",
            "telephone_number": "312-379-9476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH-MOORE",
        "first_name": "JOHN",
        "middle_name": "PATRICK",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-09-01",
        "last_updated": "2023-09-11",
        "certification_date": "2023-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.019742",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crystal Marie Smith-Coleman, M.D.
• Olivia Smith-Huang, LMSW, LCSW
• Courtney Classen Smith-Matthews
• Eryn Smith-Moeller, LCPC
• Diavione Smith-Moore
• Sean Smith-Moore, LCSW
• Janekqua Anae Smith-Nickson
• Terry Quinn Smith-Roberts, MD
• Vanessa Smith-Woods
• Aaron Smith, MD

• 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 Sep 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.