Phyllis Ferguson Collum, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149015907 Issued in IL

Practice address

15539 Dobson Ave
Dolton, IL 60419-2708

Phone

(312) 810-5203

Fax

(773) 654-3875

NPI assigned

Nov 17, 2014

Sex

Female

Sole proprietor

Yes

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.

• Advocate Health & Hospitals Corp.

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  • NPI 1750315545
  NPD
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  NPD
• Advocate Health and Hospitals Corporation

  • Multi-Specialty Clinic/Center
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  • NPI 1700824455
  NPD

Specialty

Clinical Social Worker

Education

Other, 2006

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

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

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 4, 2024.

{
    "created_epoch": "1416182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712188800000",
    "number": "1902202054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15539 DOBSON AVE",
            "city": "DOLTON",
            "state": "IL",
            "postal_code": "604192708",
            "telephone_number": "312-810-5203",
            "fax_number": "773-654-3875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15539 DOBSON AVE",
            "city": "DOLTON",
            "state": "IL",
            "postal_code": "604192708",
            "telephone_number": "312-810-5203",
            "fax_number": "773-654-3875"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9550 W 167th St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Orland Park",
            "state": "IL",
            "postal_code": "604675561",
            "country_code": "US",
            "telephone_number": "708-478-3960",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FERGUSON COLLUM",
        "first_name": "PHYLLIS",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-11-17",
        "last_updated": "2024-04-04",
        "certification_date": "2024-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "149015907",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "149015907",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149015907",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pfergusoncollum238893@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "9550 W 167th St Ste 100",
            "city": "Orland Park",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604675561",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "9550 W 167th St Ste 100",
            "city": "Orland Park",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604675561",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• All providers in Dolton, IL
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.