Active NPI
Daniel Polin Wimsatt III, MSW LCSW
- Clinical Social Worker
- Chicago, IL
National Provider Identifier
1952485963
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149012429
- Practice address
- 2755 N Pine Grove Ave
Chicago, IL 60614-6109 - Phone
- (773) 414-3565
- NPI assigned
- Oct 25, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149012429 | IL | Primary |
Addresses
Primary practice location
2755 N Pine Grove Ave
Chicago, IL 60614-6109
Mailing address
2819 N Cambridge Ave
#3S
Chicago, IL 60657-6075
Phone (773) 414-3565
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 17, 2024 through Oct 17, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149012429 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161734400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1291248000000",
"number": "1952485963",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2819 N CAMBRIDGE AVE",
"address_2": "#3S",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606576075",
"telephone_number": "773-414-3565"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2755 N PINE GROVE AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606146109",
"telephone_number": "773-414-3565"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIMSATT",
"first_name": "DANIEL",
"middle_name": "POLIN",
"name_prefix": "Mr.",
"name_suffix": "III",
"credential": "MSW LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-25",
"last_updated": "2010-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149012429",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.