Individual provider Active NPI

Donna R Siller, LCSW

  • Clinical Social Worker
  • Schaumburg, IL
National Provider Identifier
1720088388
Registry record updated Dec 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
0904001321 Issued in VA
Practice address
919 N Plum Grove Rd Ste C
Schaumburg, IL 60173-4760
Phone
(847) 413-9700
Fax
(847) 413-9700
NPI assigned
Jul 26, 2005
Last updated
Dec 27, 2019By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 27, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 0904001321 VA Primary

Addresses

Primary practice location

919 N Plum Grove Rd Ste C
Schaumburg, IL 60173-4760

Mailing address

919 N Plum Grove Rd Ste C
Schaumburg, IL 60173-4760
Phone (847) 413-9700

Other identifiers 2

IdentifierTypeStateIssuer
008919232MedicaidVA
0904001321OtherVALIC

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20150402001401 IL Practitioner - Clinical Social Worker 9739072158 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Personal Growth Associates, Inc.Group PAC ID 8921058140, 13 clinicians

Practice addresses (Care Compare)

919 N Plum Grove Rd
Suite C
Schaumburg, IL 60173-4760
Phone (847) 413-9700

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0904001321VAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Personal Growth Associates, Inc. CurrentSince Mar 2, 2015 Accepting new patients
City of Virginia Beach Past Accepting new patients
Christian Psychotherapy Services PastSince Jun 1, 1999 Accepting new patients
City of Virginia Beach Past Accepting new patients
Dr King-Jones and Associates Clinical PastSince Jul 1, 2011 Accepting new patients
Hampton Roads Neuropsychology PastSince Apr 15, 2020 Accepting new patients

Locations

919 N Plum Grove Rd
Ste C
Schaumburg, IL 60173
Phone (847) 413-9700

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/9229a1fd-2cd1-41dc-9da8-258046291286/

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1122336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577404800000",
    "number": "1720088388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "919 N PLUM GROVE RD STE C",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601734760",
            "telephone_number": "847-413-9700",
            "fax_number": "847-413-9700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "919 N PLUM GROVE RD STE C",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601734760",
            "telephone_number": "847-413-9700",
            "fax_number": "847-413-9700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SILLER",
        "first_name": "DONNA",
        "middle_name": "R",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-07-26",
        "last_updated": "2019-12-27",
        "certification_date": "2019-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904001321",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008919232",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LIC",
            "identifier": "0904001321",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Schaumburg, IL

Sources for this page

Verify at the official NPI Registry.