Individual provider Active NPI

Madison Victoria Hagene, MSW,LCSW

  • Clinical Social Worker
  • Carterville, IL
National Provider Identifier
1851928170
Registry record updated Apr 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149.025668 Issued in IL
Practice address
403 Municipal Dr
Carterville, IL 62918-2042
Phone
(855) 608-3560
Fax
(618) 956-9349
NPI assigned
Mar 25, 2020
Last updated
Apr 24, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2025

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 149.025668 IL Primary

Addresses

Primary practice location

403 Municipal Dr
Carterville, IL 62918-2042

Mailing address

902 W Main St
West Frankfort, IL 62896-2210
Phone (618) 326-2772

Other names 1

  • Madison Victoria Simon Former name

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
I20230802003818 IL Practitioner - Clinical Social Worker 7810358199 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
University of Louisville School of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Centerstone of Illinois IncGroup PAC ID 2961545173, 44 clinicians

Practice addresses (Care Compare)

403 Municipal Dr
Carterville, IL 62918-2042
Phone (855) 608-3561

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149.025668ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Centerstone of Illinois, Inc CurrentSince Jun 8, 2023 Accepting new patients
Centerstone of Illinois, Inc CurrentSince Jun 8, 2023 Accepting new patients

Locations

403 Municipal Dr
Carterville, IL 62918
Phone (618) 319-6069

902 W Main St
West Frankfort, IL 62896
Phone 6189376483 ext. 7565

Organizations & group practices 2

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": "1585094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745452800000",
    "number": "1851928170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 W MAIN ST",
            "city": "WEST FRANKFORT",
            "state": "IL",
            "postal_code": "628962210",
            "telephone_number": "618-326-2772",
            "fax_number": "618-937-1440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 MUNICIPAL DR",
            "city": "CARTERVILLE",
            "state": "IL",
            "postal_code": "629182042",
            "telephone_number": "855-608-3560",
            "fax_number": "618-956-9349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGENE",
        "first_name": "MADISON",
        "middle_name": "VICTORIA",
        "credential": "MSW,LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-25",
        "last_updated": "2025-04-24",
        "certification_date": "2025-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.025668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MADISON",
            "last_name": "SIMON",
            "middle_name": "VICTORIA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Carterville, IL

Sources for this page

Verify at the official NPI Registry.