Individual provider Active NPI

Kamaria Gye Nyame Excell, LSW

  • Clinical Social Worker
  • Chicago, IL
National Provider Identifier
1972356608
Registry record updated Apr 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
150.109545 Issued in IL
Practice address
155 N Michigan Ave Ste 450
Chicago, IL 60601-7939
Phone
(872) 395-8091
NPI assigned
Apr 11, 2024
Last updated
Apr 11, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2024

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 150.109545 IL Primary

Addresses

Primary practice location

155 N Michigan Ave Ste 450
Chicago, IL 60601-7939

Mailing address

1407 S Michigan Ave Apt 1402
Chicago, IL 60605-2836
Phone (323) 845-2767

Other identifiers 1

IdentifierTypeStateIssuer
150.109545OtherILLSW LICENSE

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
I20260527002425 IL Practitioner - Clinical Social Worker 1557831963 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2022
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

66 E Flagler St
Miami, FL 33130-1807

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
150.109545ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Cira Center for Behavioral Health PC CurrentSince Apr 14, 2024 Accepting new patients

Locations

155 N Michigan Ave
Ste 450
Chicago, IL 60601
Phone (872) 395-8091

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1712793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712793600000",
    "number": "1972356608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1407 S MICHIGAN AVE APT 1402",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606052836",
            "telephone_number": "323-845-2767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 N MICHIGAN AVE STE 450",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606017939",
            "telephone_number": "872-395-8091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EXCELL",
        "first_name": "KAMARIA",
        "middle_name": "GYE NYAME",
        "name_prefix": "Ms.",
        "credential": "LSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-11",
        "last_updated": "2024-04-11",
        "certification_date": "2024-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "150.109545",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LSW LICENSE",
            "identifier": "150.109545",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.