Individual provider Active NPI

Bruce Freeman, LCSW

  • Clinical Social Worker
  • Champaign, IL
National Provider Identifier
1780804930
Registry record updated Nov 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149001591 Issued in IL
Practice address
1813 W. Kirby Avenue
Psychiatry/Psychology
Champaign, IL 61821
Phone
(217) 383-1850
Fax
(217) 383-3439
NPI assigned
Apr 30, 2007
Last updated
Nov 26, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2013

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 149001591 IL Primary

Addresses

Primary practice location

1813 W. Kirby Avenue
Psychiatry/Psychology
Champaign, IL 61821

Mailing address

P.O. Box 6002
Urbana, IL 61803-6002
Phone (217) 326-8300

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
I20040511000859 IL Practitioner - Clinical Social Worker 4789673047 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Carle Health Care IncorporatedGroup PAC ID 3577515774, 1,592 clinicians

Practice addresses (Care Compare)

1802 S Mattis Ave
Champaign, IL 61821-5923
Phone (217) 326-1330

611 W Park St
Urbana, IL 61801-2501
Phone (888) 712-2753

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Carle Health Medical Group CurrentSince Apr 1, 2010 Accepting new patients

Locations

1813 W Kirby Ave
Champaign, IL 61821
Phone (217) 383-1850

809 W Church St
Champaign, IL 61820
Phone (217) 373-1700

311 W Fairchild St
Danville, IL 61832
Phone (217) 431-7600

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

Organizations & group practices 1

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": "1177891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1385424000000",
    "number": "1780804930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 6002",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618036002",
            "telephone_number": "217-326-8300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1813 W. KIRBY AVENUE",
            "address_2": "PSYCHIATRY/PSYCHOLOGY",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "61821",
            "telephone_number": "217-383-1850",
            "fax_number": "217-383-3439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREEMAN",
        "first_name": "BRUCE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-30",
        "last_updated": "2013-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149001591",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Champaign, IL

Sources for this page

Verify at the official NPI Registry.