Individual provider Active NPI

Kristina Anderson, LCSW

  • Clinical Social Worker
  • Naperville, IL
National Provider Identifier
1861049611
Registry record updated May 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149.010678 Issued in IL
Practice address
640 S Washington St
Naperville, IL 60540-6603
Phone
(815) 942-6323
Fax
(815) 942-6363
NPI assigned
Aug 26, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2023

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 149.010678 IL Primary

Addresses

Primary practice location

640 S Washington St
Naperville, IL 60540-6603

Mailing address

PO Box 713260
Chicago, IL 60677-0018
Phone (630) 469-9200

Other practice location 1

800 Main St Ste 210
Antioch, IL 60002-1578
Phone (849) 903-5604

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kanderson250070@dulyhealthandcare.direct-ci.com Direct

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
I20190912000242 IL Practitioner - Clinical Social Worker 1153650460 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Dupage Medical Group LTDGroup PAC ID 5496667941, 1,326 clinicians

Practice addresses (Care Compare)

30 Stratford Dr
Bloomingdale, IL 60108-2201
Phone (630) 893-2210

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149.010678ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Dupage Medical Group LTD CurrentSince Aug 22, 2022 Accepting new patients
Dupage Medical Group LTD CurrentSince Aug 22, 2022 Accepting new patients

Locations

30 Stratford Dr
Bloomingdale, IL 60108
Phone (630) 893-2210

1860 Paysphere Cir
Chicago, IL 60674
Phone (630) 469-2000

640 S Washington St
Naperville, IL 60540
Phone (630) 428-1500

Interoperability endpoints

  • Direct secure messaging: kanderson250070@dulyhealthandcare.direct-ci.com

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1566777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684454400000",
    "number": "1861049611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 713260",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606770018",
            "telephone_number": "630-469-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 S WASHINGTON ST",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605406603",
            "telephone_number": "815-942-6323",
            "fax_number": "815-942-6363"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 Main St Ste 210",
            "address_purpose": "LOCATION",
            "city": "Antioch",
            "state": "IL",
            "postal_code": "600021578",
            "country_code": "US",
            "telephone_number": "849-903-5604",
            "fax_number": "224-788-5112",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "KRISTINA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-26",
        "last_updated": "2023-05-19",
        "certification_date": "2023-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.010678",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kanderson250070@dulyhealthandcare.direct-ci.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "640 S Washington St",
            "city": "Naperville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605406603",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Naperville, IL

Sources for this page

Verify at the official NPI Registry.