Evan Michael Willmore, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.024489 Issued in IL

Practice address

50 Northgate Industrial Dr
Granite City, IL 62040-6805

Phone

(618) 877-4420

NPI assigned

Apr 21, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Chestnut Health Systems Inc

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Bloomington, IL
  • NPI 1366431686
  NPD
• Chestnut Health Systems Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Wood River, IL
  • NPI 1235941311
  NPD
• Chestnut Health Systems Inc

  • Substance Abuse Rehabilitation Facility
  • Granite City, IL
  • NPI 1609144815
  NPD (past)

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

{
    "created_epoch": "1650499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650499200000",
    "number": "1710621271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "448 WYLIE DR",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617615405",
            "telephone_number": "618-512-1803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 NORTHGATE INDUSTRIAL DR",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620406805",
            "telephone_number": "618-877-4420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLMORE",
        "first_name": "EVAN",
        "middle_name": "MICHAEL",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-21",
        "last_updated": "2022-04-21",
        "certification_date": "2022-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.024489",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linda Carol White, LCPC
• Joshua Daniel Wideman, DC
• Darla Jo Williams, R.N.
• John R Williams Jr., MD
• Sarah J Williamson, MSN, RN
• Jason A Winship
• Laura A Winter, RPH
• Kacey Woulfe, CPNP-PC
• Whitney Danielle Young-Brown, APN
• Nelson C Yu, MD

• Clinical Social Worker in Granite City, IL
• Providers in Granite City, 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 Apr 21, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.