Active NPI
Jesus Emmanuel Reyes, LCSW
- Clinical Social Worker
- Lansing, IL
National Provider Identifier
1639645260
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149.004510
- Practice address
- 18555 Carriage LN
Lansing, IL 60438-2535 - Phone
- (708) 220-2175
- NPI assigned
- Oct 22, 2018
- Sex
- Male
- Sole proprietor
- Yes
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 | 149.004510 | IL | Primary |
Addresses
Primary practice location
18555 Carriage LN
Lansing, IL 60438-2535
Mailing address
18555 Carriage LN
Lansing, IL 60438-2535
Phone (708) 220-2175
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 149.004510 | Other | IL | ILLINOIS DEPT OF FINANCIAL & PROFESSIONAL REGULATION |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210813000956 | IN | Practitioner - Clinical Social Worker | 5193067841 | Practice locations: Schererville, IN |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 1985
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
1454 Inverness LN
Schererville, IN 46375-2929
Phone (708) 220-2175
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1540166400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1540166400000",
"number": "1639645260",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18555 CARRIAGE LN",
"city": "LANSING",
"state": "IL",
"postal_code": "604382535",
"telephone_number": "708-220-2175"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18555 CARRIAGE LN",
"city": "LANSING",
"state": "IL",
"postal_code": "604382535",
"telephone_number": "708-220-2175"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REYES",
"first_name": "JESUS",
"middle_name": "EMMANUEL",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-10-22",
"last_updated": "2018-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149.004510",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ILLINOIS DEPT OF FINANCIAL & PROFESSIONAL REGULATION",
"identifier": "149.004510",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lansing, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2018; 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.