Individual provider Active NPI

Sonya Masterson, LCSW

  • Clinical Social Worker
  • Fairview Heights, IL
National Provider Identifier
1871996074
Registry record updated Mar 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149019125 Issued in IL
Practice address
41 Annex CT
Fairview Heights, IL 62208-1901
Phone
(618) 420-3975
NPI assigned
Oct 1, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 13, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Clinical Social Worker 1041C0700X 149019125 IL Primary

Addresses

Primary practice location

41 Annex CT
Fairview Heights, IL 62208-1901

Mailing address

41 Annex CT
Fairview Heights, IL 62208-1901
Phone (618) 420-3975

Other practice location 1

101 S Belt W
Belleville, IL 62220-2503
Phone (618) 420-3975

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
I20240501002310 IL Practitioner - Clinical Social Worker 0547600058 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ultacare Medical PLLCGroup PAC ID 4789687484, 52 clinicians

Practice addresses (Care Compare)

410 E Mack Ave
Olney, IL 62450-2319
Phone (710) 658-6338

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149019125ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Ultacare Medical PLLC Clinical CurrentSince Mar 20, 2024 Accepting new patients

Locations

7951 E Maplewood Ave
Ste 118
Greenwood Village, CO 80111

40 N 64th St
Belleville, IL 62223
Phone (618) 397-8400

101 S Belt W
Belleville, IL 62220
Phone (618) 227-2700

101 S Belt W
Ste 118
Belleville, IL 62220

210 E College St
Energy, IL 62933
Phone (618) 942-7014

410 E Mack Ave
Olney, IL 62450
Phone (618) 395-7421

5261 Carrollton Pike
Ste A
Woodlawn, VA 24381

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": "1412121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710288000000",
    "number": "1871996074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 ANNEX CT",
            "city": "FAIRVIEW HEIGHTS",
            "state": "IL",
            "postal_code": "622081901",
            "telephone_number": "618-420-3975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41 ANNEX CT",
            "city": "FAIRVIEW HEIGHTS",
            "state": "IL",
            "postal_code": "622081901",
            "telephone_number": "618-420-3975"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 S Belt W",
            "address_purpose": "LOCATION",
            "city": "Belleville",
            "state": "IL",
            "postal_code": "622202503",
            "country_code": "US",
            "telephone_number": "618-420-3975",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MASTERSON",
        "first_name": "SONYA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-10-01",
        "last_updated": "2024-03-13",
        "certification_date": "2024-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149019125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairview Heights, IL

Sources for this page

Verify at the official NPI Registry.