Organization Active NPI

Nancy Smith L.C.S.W.,P.C.

  • Clinical Social Worker
  • Chicago, IL
National Provider Identifier
1780863142
Registry record updated Jan 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
NANCY SMITH L.C.S.W.,P.C.
Practice address
4753 N Broadway St
#928
Chicago, IL 60640-5266
Phone
(773) 878-8440
NPI assigned
Nov 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2008

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

Authorized official

Name
Ms. Nancy SmithNPI 1326106188
Title
Psychotherapist
Phone
(773) 878-8440

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X IL Primary

Addresses

Primary practice location

4753 N Broadway St
#928
Chicago, IL 60640-5266

Mailing address

4753 N Broadway St
#928
Chicago, IL 60640-5266
Phone (773) 878-8440

Other identifiers 1

IdentifierTypeStateIssuer
215888OtherILMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071228000024 IL Part B Supplier - Clinic/Group Practice 0941380281 Receives reassigned benefits from 1 practitioner
Practice locations: Evanston, IL

National Provider Directory

National Provider Directory

Locations

4753 N Broadway St
#928
Chicago, IL 60640
Phone (773) 878-8440

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1193875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200441600000",
    "number": "1780863142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4753 N BROADWAY ST",
            "address_2": "#928",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405266",
            "telephone_number": "773-878-8440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4753 N BROADWAY ST",
            "address_2": "#928",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405266",
            "telephone_number": "773-878-8440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NANCY SMITH L.C.S.W.,P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-01",
        "last_updated": "2008-01-16",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "NANCY",
        "authorized_official_title_or_position": "PSYCHOTHERAPIST",
        "authorized_official_telephone_number": "773-878-8440",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "215888",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.