Edrena Davis

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Practice address

1909 Cheker SQ
Hazel Crest, IL 60429-1442

Phone

(708) 331-0500

NPI assigned

May 15, 2013

Sex

Female

Sole proprietor

No

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

Specialty

Clinical Social Worker

Education

Other, 2007

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Advanced Clinical Health Service Corporation

  • Clinical Social Worker
  • Chicago, IL
  • NPI 1891200317
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1368576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1368576000000",
    "number": "1619313889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1909 CHEKER SQ",
            "city": "HAZEL CREST",
            "state": "IL",
            "postal_code": "604291442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1909 CHEKER SQ",
            "city": "HAZEL CREST",
            "state": "IL",
            "postal_code": "604291442",
            "telephone_number": "708-331-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "EDRENA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-15",
        "last_updated": "2013-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eileen Frances Couture, DO
• Kimberly Coy
• Chandra Curry, MD
• David L. McFadden,M.D.,S.C.
• Shirley Jean Davis-Barsh, LCSW
• Mark De Silva, M.D.
• Mary Louise Deans
• Jayne L Dederichs, OTRL
• Michelle G Delgadillo, NP
• Kristin Lee Delleman, RD, LDN

• Behavior Analyst in Hazel Crest, IL
• Providers in Hazel Crest, IL by specialty
• Behavior Analyst in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2013; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.