Individual provider Active NPI

Jessica Nicole Thomas

  • Clinical Social Worker
  • Pekin, IL
National Provider Identifier
1932848934
Registry record updated May 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149.025552 Issued in IL
Practice address
2205 State St
Pekin, IL 61554-3936
Phone
(630) 428-7890
NPI assigned
May 31, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 149.025552 IL Primary
Mental Health Counselor 101YM0800X IL
Social Worker 104100000X IL

Addresses

Primary practice location

2205 State St
Pekin, IL 61554-3936

Mailing address

4800 N Scottsdale Rd Ste 2500
Scottsdale, AZ 85251-7630
Phone (630) 428-7890

Other practice location 1

4600 3rd St
Moline, IL 61265-6106
Phone (309) 779-2031

Other practice location 2

5901 N Prospect Rd Ste 201A
Peoria, IL 61614-4346
Phone (630) 428-7890

Other names 1

  • Jessica Nicole Urish Former name

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
I20230804002651 IL Practitioner - Clinical Social Worker 5799146841 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Edgewood Clinical Services P.C.Group PAC ID 3971963901, 304 clinicians

Practice addresses (Care Compare)

5901 N Prospect Rd
Suite 201a
Peoria, IL 61614-4346
Phone (888) 428-7890

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149.025552ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Post Acute Care PLLC Clinical CurrentSince Jul 1, 2023 Accepting new patients
Edgewood Clinical Services, P.C. Mental Health CurrentSince Mar 22, 2025 Accepting new patients
Siebert Moazzam P C CurrentSince Mar 22, 2025 Accepting new patients
Psychology Specialists LTD PastSince Mar 22, 2025 Accepting new patients
Edgewood Clinical Services, P.C. Past Accepting new patients
Psychology Specialists LTD Clinical Past Accepting new patients

Locations

4800 N Scottsdale Rd
Ste 2500
Scottsdale, AZ 85251
Phone (253) 346-0392

808 S Eldorado Rd
Ste 102
Bloomington, IL 61704
Phone (309) 212-6007

2045 W Grand Ave
Ste B
Chicago, IL 60612
Phone (800) 827-7437

2948 Artesian Rd
Ste 112
Naperville, IL 60564
Phone (630) 328-0165

2205 State St
Pekin, IL 61554
Phone (309) 353-1833

5901 N Prospect Rd
Ste 201A
Peoria, IL 61614
Phone (309) 648-0782

1629 E Gardner Ln
Peoria Heights, IL 61616
Phone (309) 605-1545

1201 Newcastle Rd
Washington, IL 61571
Phone (309) 444-1065

Organizations & group practices 6

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": "1653955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747094400000",
    "number": "1932848934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 N SCOTTSDALE RD STE 2500",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852517630",
            "telephone_number": "630-428-7890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2205 STATE ST",
            "city": "PEKIN",
            "state": "IL",
            "postal_code": "615543936",
            "telephone_number": "630-428-7890"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4600 3rd St",
            "address_purpose": "LOCATION",
            "city": "Moline",
            "state": "IL",
            "postal_code": "612656106",
            "country_code": "US",
            "telephone_number": "309-779-2031",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5901 N Prospect Rd Ste 201A",
            "address_purpose": "LOCATION",
            "city": "Peoria",
            "state": "IL",
            "postal_code": "616144346",
            "country_code": "US",
            "telephone_number": "630-428-7890",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "JESSICA",
        "middle_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-31",
        "last_updated": "2025-05-13",
        "certification_date": "2025-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.025552",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "URISH",
            "middle_name": "NICOLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Pekin, IL

Sources for this page

Verify at the official NPI Registry.