Individual provider Active NPI

Jasmine Lee Royal

  • Clinical Social Worker
  • Chicago, IL
National Provider Identifier
1922734607
Registry record updated Apr 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149029106 Issued in IL
Practice address
1029 E 130TH St
Chicago, IL 60628-6908
Phone
(773) 995-6300
NPI assigned
Jul 26, 2022
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 15, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 150.107425 IL
Clinical Social Worker 1041C0700X 149029106 IL Primary

Addresses

Primary practice location

1029 E 130TH St
Chicago, IL 60628-6908

Mailing address

1029 E 130TH St
Chicago, IL 60628-6908
Phone (773) 995-6300

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
I20250501002549 IL Practitioner - Clinical Social Worker 9537685532 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tca Health Inc NFPGroup PAC ID 5991696643, 18 clinicians

Practice addresses (Care Compare)

1029 E 130TH St
Chicago, IL 60628-6908
Phone 7739956300254

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
150.107425ILMDSocial Worker
149029106ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Tca Health Inc NFP CurrentSince Feb 28, 2025 Accepting new patients
Innovative Platinum Care, SC CurrentSince Nov 1, 2025 Accepting new patients
Tca Health Inc NFP CurrentSince Feb 28, 2025 Accepting new patients

Locations

1029 E 130th St
Chicago, IL 60628
Phone (773) 995-6300

2400 N Ashland Ave
Chicago, IL 60614
Phone (773) 259-7180

8425 S Cottage Grove Ave
Chicago, IL 60619
Phone (708) 225-0643

Organizations & group practices 3

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": "1658793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744675200000",
    "number": "1922734607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1029 E 130TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606286908",
            "telephone_number": "773-995-6300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1029 E 130TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606286908",
            "telephone_number": "773-995-6300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROYAL",
        "first_name": "JASMINE",
        "middle_name": "LEE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-07-26",
        "last_updated": "2025-04-15",
        "certification_date": "2025-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IL",
            "license": "150.107425",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149029106",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.