Active NPI
Macy Yvette Ferguson-Smith, LCSW
- Clinical Social Worker
- Quincy, IL
National Provider Identifier
1881192979
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149021107
- Practice address
- 1025 Maine St
Quincy, IL 62301-4096 - Phone
- (217) 592-0413
- Fax
- (217) 277-2253
- NPI assigned
- Jan 24, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 150102867 | IL | |
| Clinical Social Worker | 1041C0700X | 149021107 | IL | Primary |
Addresses
Primary practice location
1025 Maine St
Quincy, IL 62301-4096
Mailing address
1025 Maine St
Quincy, IL 62301-4096
Phone (217) 222-6550
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 150102867 | Other | IL | STATE OF ILLINOIS |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190423001190 | IL | Practitioner - Clinical Social Worker | 3476895483 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 150102867 | IL | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Quincy Physicians & Surgeons Clinic, PLLC | Current | Accepting new patients |
Locations
1025 Maine St
Quincy, IL 62301
Phone 21722265503163
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.
-
- Clinic/Center
- Quincy, IL
- NPI 1548234198
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1516752000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611532800000",
"number": "1881192979",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1025 MAINE ST",
"city": "QUINCY",
"state": "IL",
"postal_code": "623014096",
"telephone_number": "217-222-6550",
"fax_number": "217-277-2253"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1025 MAINE ST",
"city": "QUINCY",
"state": "IL",
"postal_code": "623014096",
"telephone_number": "217-592-0413",
"fax_number": "217-277-2253"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FERGUSON-SMITH",
"first_name": "MACY",
"middle_name": "YVETTE",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-01-24",
"last_updated": "2021-01-25",
"certification_date": "2021-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IL",
"license": "150102867",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149021107",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF ILLINOIS",
"identifier": "150102867",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Quincy, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.