Raul Rodriguez, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149017750 Issued in IL

Practice address

12204 Gregory St
Blue Island, IL 60406-1318

Phone

(708) 369-0960

NPI assigned

Aug 21, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: raul.rodriguez.p21@direct.fhn-fqhc.nextgenshare.com
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Beloved Community Family Wellness Center

  • Primary Care Clinic/Center
  • Chicago, IL
  • NPI 1760408439
  Medicare reassignment NPD
• Beloved Community Family Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Blue Island, IL
  • NPI 1114278009
  NPD

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

{
    "created_epoch": "1629504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629504000000",
    "number": "1881360584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12204 GREGORY ST",
            "city": "BLUE ISLAND",
            "state": "IL",
            "postal_code": "604061318",
            "telephone_number": "708-369-0960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12204 GREGORY ST",
            "city": "BLUE ISLAND",
            "state": "IL",
            "postal_code": "604061318",
            "telephone_number": "708-369-0960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "RAUL",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-08-21",
        "last_updated": "2021-08-21",
        "certification_date": "2021-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149017750",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linda Rink, CRNA
• Angela I Risser, MD
• Ritl Medical Services SC
• Robert M. Gasior, M.D., F.a.C.S., S.C.
• Jessica Vanessa Rodriguez, LPCC
• Janae Neycole Rogers, M.ED.
• Alan Marshall Roman, MD
• Ronnie Ata Consulting
• Natalie Ruffner
• Lashon Rushing, PHARM. D.

• Clinical Social Worker in Blue Island, IL
• Providers in Blue Island, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 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.

Verify at the official NPI Registry.