Phillip A. Wilburn, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

34001917A Issued in IN

Practice address

5241 Fountain Dr
Suite G
Crown Point, IN 46307-5323

Phone

(219) 381-5648

Fax

(219) 736-2998

NPI assigned

Jul 17, 2006

Sex

Male

Sole proprietor

Yes

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

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

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.

• Icg Services, LLC

  • Adolescent and Children Mental Health Clinic/Center
  • Chicago, IL
  • NPI 1659090827
  NPD (past)

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323475200000",
    "number": "1720005440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3938 W 78TH CT",
            "address_2": "# 31",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464108705",
            "telephone_number": "219-381-5648",
            "fax_number": "219-736-2998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5241 FOUNTAIN DR",
            "address_2": "SUITE G",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463075323",
            "telephone_number": "219-381-5648",
            "fax_number": "219-736-2998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILBURN",
        "first_name": "PHILLIP",
        "middle_name": "A.",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2011-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34001917A",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149-001105",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Denise Whitfield, R.PH
• Christena S Wichowsky, PT
• Carli J Wiersema, NP
• Timothy E. Wiess, MD
• Nicole Denise Wilbanks, APRN
• Ivy Wilcher
• Jeffrey Michael Wilkinson, D.D.S.
• Williams Eye Institute, PC
• Douglas P Williams MD, M.D.
• Sarah Ann Williams-Perez, MSN, FNP-BC

• Clinical Social Worker in Crown Point, IN
• Providers in Crown Point, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2011; 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.