MR. CHARLES FRANCIS SMALL III L.S.W.
NPI 1053673053
Social Worker - Clinical in Chicago, IL

Active since June 14, 2012Opted out of Medicare · through Feb 8, 2028
1645 W JACKSON BLVD, SUITE 302, CHICAGO, IL 60612(312) 942-8318 Get Directions Write a Review

NPPES record last updated: April 5, 2017. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mr. Charles Francis Small Iii L.s.w. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. CHARLES FRANCIS SMALL III L.S.W. (NPI 1053673053) is an individual clinical provider in Chicago, Illinois, licensed in Illinois (149.015676) and active in the NPI registry since June 2012. He has opted out of Medicare through February 8, 2028.

NPPES Registry Identity

NPI1053673053
Entity TypeIndividualMale
Primary Taxonomy1041C0700X
Provider Legal NameMR. CHARLES FRANCIS SMALL IIICredential: L.S.W.
Location Address1645 W JACKSON BLVD, SUITE 302Chicago, IL 60612-3276
Mailing Address1645 W Jackson Blvd, Suite 302Chicago, IL 60612-3276 · (312) 942-8318
Sole ProprietorNo
Enumeration DateJune 14, 2012
Last NPPES UpdateApril 5, 2017
NPI 1053673053 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License Licensed in IL · 149.015676
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
1645 W JACKSON BLVD, Chicago, IL 60612

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Opted out of Medicare

Mr. Charles Francis Small Iii L.s.w. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from February 8, 2022 through February 8, 2028.

Opt-Out Effective DateFebruary 8, 2022
Opt-Out In Effect ThroughFebruary 8, 2028Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Pediatrics
1645 W JACKSON BLVD, STE 200
CHICAGO, IL 60612
Pediatrics
1645 W JACKSON BLVD
CHICAGO, IL 60612
Pediatrics
1645 W JACKSON BLVD, SUITE 200
CHICAGO, IL 60612
Pediatrics
1645 W JACKSON BLVD
CHICAGO, IL 60612
Pediatrics
1645 W JACKSON BLVD, SUITE 215
CHICAGO, IL 60612
Pediatrics
1645 W JACKSON BLVD
CHICAGO, IL 60612
Psychiatry & Neurology (Psychiatry)
1645 W JACKSON BLVD, SUITE 600
CHICAGO, IL 60612
Pediatrics
1645 W JACKSON BLVD, SUITE 200
CHICAGO, IL 60612

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Charles Small's NPI number?

The NPI number for Charles Small is 1053673053. It was assigned to this individual provider in the NPPES registry on June 14, 2012.

Where is Charles Small located?

Charles Small practices at 1645 W Jackson Blvd Suite 302, Chicago, IL 60612. The listed phone number is (312) 942-8318.

What is Charles Small's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Charles Small enrolled in Medicare?

No. Charles Small has opted out of Medicare through February 8, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Charles Small was last updated on April 5, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.