Active NPI
Katherine Eileen Johnson, LCSW
- Clinical Social Worker
- Springfield, IL
National Provider Identifier
1639404908
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149.014404
- Practice address
- 901 S 2ND St Ste 201
Springfield, IL 62704-7909 - Phone
- (423) 486-0774
- NPI assigned
- Oct 5, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149.014404 | IL | Primary |
Addresses
Primary practice location
901 S 2ND St Ste 201
Springfield, IL 62704-7909
Mailing address
1101 W 40TH St Unit 2225
Chattanooga, TN 37409-1379
Phone (877) 358-2998
Other names 1
- Katherine Eileen Kennedy
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, 2008
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
901 S 2ND St
Suite 201
Springfield, IL 62704-7909
Phone (877) 358-2998
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149.014404 | IL | MD | Clinical Social Worker |
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": "1254700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683590400000",
"number": "1639404908",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1101 W 40TH ST UNIT 2225",
"city": "CHATTANOOGA",
"state": "TN",
"postal_code": "374091379",
"telephone_number": "877-358-2998",
"fax_number": "423-405-6346"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "901 S 2ND ST STE 201",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627047909",
"telephone_number": "423-486-0774"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "KATHERINE",
"middle_name": "EILEEN",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-10-05",
"last_updated": "2023-05-09",
"certification_date": "2023-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149.014404",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KATHERINE",
"last_name": "KENNEDY",
"middle_name": "EILEEN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Springfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2023; 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.