Individual provider Active NPI

Damaso Allen Hodges, LCSW

  • Clinical Social Worker
  • Chicago, IL
National Provider Identifier
1639443138
Registry record updated Nov 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149021755 Issued in IL
Practice address
1639 W Foster Ave Apt 2
Chicago, IL 60640-2086
Phone
(330) 280-3032
NPI assigned
Mar 1, 2012
Last updated
Nov 20, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 20, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 150101823 IL
Clinical Social Worker 1041C0700X 149021755 IL Primary
Early Intervention Provider Agency 252Y00000X NU

Addresses

Primary practice location

1639 W Foster Ave Apt 2
Chicago, IL 60640-2086

Mailing address

1996 Apache TRL
Round Lake Beach, IL 60073-1365
Phone (330) 280-3032

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200220001407 IL Practitioner - Clinical Social Worker 6901233519 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Yusuf Salah LLCGroup PAC ID 3577895176, 45 clinicians

Practice addresses (Care Compare)

759 Kane St
South Elgin, IL 60177-1418
Phone (847) 697-3310

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
150101823ILMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Vitae Health Medical Illinois, PLLC Clinical CurrentSince Jan 12, 2020 Accepting new patients
Yusuf Salah LLC CurrentSince Oct 1, 2023 Accepting new patients

Locations

303 E Wacker Dr
Ste 1127
Chicago, IL 60601
Phone (312) 328-2347

19550 Governors Hwy
Flossmoor, IL 60422
Phone (708) 799-8400

6321 Dempster St
Morton Grove, IL 60053

759 Kane St
South Elgin, IL 60177
Phone (847) 697-2056

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1330560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574208000000",
    "number": "1639443138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1996 APACHE TRL",
            "city": "ROUND LAKE BEACH",
            "state": "IL",
            "postal_code": "600731365",
            "telephone_number": "330-280-3032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1639 W FOSTER AVE APT 2",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606402086",
            "telephone_number": "330-280-3032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HODGES",
        "first_name": "DAMASO",
        "middle_name": "ALLEN",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-03-01",
        "last_updated": "2019-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IL",
            "license": "150101823",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149021755",
            "primary": true
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.