Individual provider Active NPI

Felisa Gutierrez, LCSW

  • Clinical Social Worker
  • Chicago, IL
National Provider Identifier
1891340717
Registry record updated Dec 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149021443 Issued in IL
Practice address
5359 W Fullerton Ave
Chicago, IL 60639-1450
Phone
(773) 836-2785
Fax
(773) 836-7381
NPI assigned
Aug 7, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 24, 2019

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 149021443 IL Primary

Addresses

Primary practice location

5359 W Fullerton Ave
Chicago, IL 60639-1450

Mailing address

5359 W Fullerton Ave
Chicago, IL 60639-1450
Phone (773) 836-2785

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
I20191002001457 IL Practitioner - Clinical Social Worker 8729318829 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
PCC Community Wellness CenterGroup PAC ID 1557270139, 91 clinicians

Practice addresses (Care Compare)

14 Lake St
Oak Park, IL 60302-2606
Phone 7083830113220005

5425 W Lake St
Chicago, IL 60644-2342
Phone (773) 413-1920

5461 W Lake St
Chicago, IL 60644-2342
Phone 7083830113220005

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
PCC Community Wellness Center CurrentSince Sep 6, 2019 Accepting new patients
PCC Community Wellness Center CurrentSince Sep 6, 2019 Accepting new patients

Locations

5359 W Fullerton Ave
Chicago, IL 60639
Phone (773) 836-2785

14 Lake St
Oak Park, IL 60302
Phone (708) 383-0113

Interoperability endpoints

  • Direct secure messaging: felisa.gutierrez.1@13158.direct.athenahealth.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": "1565136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577145600000",
    "number": "1891340717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5359 W FULLERTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606391450",
            "telephone_number": "773-836-2785",
            "fax_number": "773-836-7381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5359 W FULLERTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606391450",
            "telephone_number": "773-836-2785",
            "fax_number": "773-836-7381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUTIERREZ",
        "first_name": "FELISA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-07",
        "last_updated": "2019-12-24",
        "certification_date": "2019-12-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149021443",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.