Individual provider Active NPI

Renae T Mendez, LCSW

  • Clinical Social Worker
  • Park Ridge, IL
National Provider Identifier
1871891788
Registry record updated Jan 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149.022995 Issued in IL
Practice address
1440 Renaissance Dr Ste 320
Park Ridge, IL 60068-1471
Phone
(872) 216-7736
NPI assigned
Mar 2, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 149.022995 IL Primary
Clinical Social Worker 1041C0700X LCSW-3622 HI

Addresses

Primary practice location

1440 Renaissance Dr Ste 320
Park Ridge, IL 60068-1471

Mailing address

4002 Niblick CT
Prairie Grove, IL 60012-2242
Phone (808) 286-5688

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
I20211012002032 IL Practitioner - Clinical Social Worker 3779981337 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Juniper Center PCGroup PAC ID 1557557725, 26 clinicians

Practice addresses (Care Compare)

1440 Renaissance Dr
Suite 320
Park Ridge, IL 60068-1471
Phone (847) 778-4533

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCSW-3622HIMDClinical Social Worker
149.022995ILMDClinical Social Worker

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1299024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674777600000",
    "number": "1871891788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4002 NIBLICK CT",
            "city": "PRAIRIE GROVE",
            "state": "IL",
            "postal_code": "600122242",
            "telephone_number": "808-286-5688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1440 RENAISSANCE DR STE 320",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681471",
            "telephone_number": "872-216-7736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDEZ",
        "first_name": "RENAE",
        "middle_name": "T",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-02",
        "last_updated": "2023-01-27",
        "certification_date": "2023-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.022995",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "HI",
            "license": "LCSW-3622",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Park Ridge, IL

Sources for this page

Verify at the official NPI Registry.