Active NPI
Nina M Williams, LCSW
- Social Worker
- Matteson, IL
National Provider Identifier
1639359698
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 149021613
- Practice address
- 21317 S Jeffrey Dr
Matteson, IL 60443-2467 - Phone
- (363) 944-5897
- NPI assigned
- Nov 7, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 0904008569 | VA | |
| Clinical Social Worker | 1041C0700X | P006305 | NC | |
| Clinical Social Worker | 1041C0700X | 149021613 | IL | |
| Social Worker | 104100000X | 149021613 | IL | Primary |
Addresses
Primary practice location
21317 S Jeffrey Dr
Matteson, IL 60443-2467
Mailing address
203 Wysteria Dr
Olympia Fields, IL 60461-1202
Phone (336) 944-5897
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6005168 | Medicaid | NC |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
9730 S Western Ave
Suite 350
Evergreen Park, IL 60805-2814
Phone (855) 284-7483
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P006305 | NC | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thriveworks Clinical - Illinois | Multi-Specialty | Current | Accepting new patients |
Locations
333 N Michigan Ave
Ste 1810
Chicago, IL 60601
Phone (217) 850-1133
9730 S Western Ave
Ste 350
Evergreen Park, IL 60805
Organizations & group practices 1
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": "1194393600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705536000000",
"number": "1639359698",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "203 WYSTERIA DR",
"city": "OLYMPIA FIELDS",
"state": "IL",
"postal_code": "604611202",
"telephone_number": "336-944-5897"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21317 S JEFFREY DR",
"city": "MATTESON",
"state": "IL",
"postal_code": "604432467",
"telephone_number": "363-944-5897"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "NINA",
"middle_name": "M",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-11-07",
"last_updated": "2024-01-18",
"certification_date": "2024-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "VA",
"license": "0904008569",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "P006305",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149021613",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IL",
"license": "149021613",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6005168",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Matteson, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 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.
- 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.