Jerome Pietrusiak, LICENSED CLINICAL SO

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.002241 Issued in IL

Practice address

3456 W Franklin Blvd
Chicago, IL 60624-1308

Phone

(773) 533-6013

NPI assigned

Apr 27, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Specialty

Clinical Social Worker

Education

Other, 1983

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

PCC Community Wellness CenterGroup PAC ID 1557270139, 91 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jerome.pietrusiak.1@13158.direct.athenahealth.com

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.

• PCC Community Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Oak Park, IL
  • NPI 1871516799
  Medicare reassignment Care Compare group NPD
• PCC Community Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1134954506
  NPD

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

{
    "created_epoch": "1177632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577318400000",
    "number": "1679793913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2105 SUNNYSIDE",
            "city": "WESTCHESTER",
            "state": "IL",
            "postal_code": "601545205",
            "telephone_number": "708-562-9070",
            "fax_number": "708-562-9073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3456 W FRANKLIN BLVD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606241308",
            "telephone_number": "773-533-6013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PIETRUSIAK",
        "first_name": "JEROME",
        "name_prefix": "Mr.",
        "credential": "LICENSED CLINICAL SO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-27",
        "last_updated": "2019-12-26",
        "certification_date": "2019-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IL",
            "license": "149002241",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.002241",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Marie Pietro, OTD, OTR/L
• Megan E Pietrucha, PSY.D.
• Rachel Pietrucha, D.C.
• Irene Pietruczyk
• Michael R Pietrus, PSY.D
• Leslie Rae Pietruszka
• Matthew Daniel Pietruszka, OD
• Aaron Pietrykowski
• John Pietrykowski
• Agnieszka Beata Pietrzak, D.O.

• Clinical Social Worker in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2019; 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.

Verify at the official NPI Registry.