Kimberly Denae Washburn, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149017470 Issued in IL

Practice address

1100 Sandy Duncan Dr
Taylorville, IL 62568

Phone

(217) 823-1395

NPI assigned

Nov 29, 2017

Last updated

Nov 29, 2017By the provider in NPPES

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

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, 2013

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Midwest Post Acute Care PLLC

  • Nurse Practitioner
  • Chicago, IL
  • NPI 1083012074
  Medicare reassignment
• Acorn Counseling & Mediation, LTD

  • Community/Behavioral Health Agency
  • Carlinville, IL
  • NPI 1225490915
  NPD (past)

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

{
    "created_epoch": "1511913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1511913600000",
    "number": "1619481629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 SANDY DUNCAN DR",
            "city": "TAYLORVILLE",
            "state": "IL",
            "postal_code": "62568",
            "telephone_number": "217-823-1395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 SANDY DUNCAN DR",
            "city": "TAYLORVILLE",
            "state": "IL",
            "postal_code": "62568",
            "telephone_number": "217-823-1395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASHBURN",
        "first_name": "KIMBERLY",
        "middle_name": "DENAE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-11-29",
        "last_updated": "2017-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149017470",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen J Vatthauer, LCPC, BCPC
• Wal-Mart Stores, Inc (Vision Center 30-0343)
• Walgreen Co (Walgreens #09892)
• Walgreen Co. (Walgreens #9892)
• Walmart Inc.
• Barbara Westrick White
• Whole Family Wellness LLC
• Amber Dawn Williams, LCPC
• Johanna Maria Paulien Williams, LCSW
• Morgan Kathleen Winans, APRN, CNP

• Clinical Social Worker in Taylorville, IL
• Providers in Taylorville, 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 Nov 29, 2017; 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.