Active NPI
John Williams
- Clinical Social Worker
- Chicago, IL
National Provider Identifier
1649533829
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149.015250
- Practice address
- 5209 N Clark St
2ND Floor
Chicago, IL 60640-2101 - Phone
- (773) 575-1792
- NPI assigned
- Jun 21, 2012
- 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 | 149.015250 | IL | Primary |
Addresses
Primary practice location
5209 N Clark St
2ND Floor
Chicago, IL 60640-2101
Mailing address
5415 N Sheridan Rd
Apt. 5308
Chicago, IL 60640-1954
Phone (773) 575-1792
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Sep 3, 2021 through Sep 3, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149.015250 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340236800000",
"number": "1649533829",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5415 N SHERIDAN RD",
"address_2": "APT. 5308",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606401954",
"telephone_number": "773-575-1792"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5209 N CLARK ST",
"address_2": "2ND FLOOR",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606402101",
"telephone_number": "773-575-1792"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "JOHN",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-06-21",
"last_updated": "2012-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149.015250",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.