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BLUE MOON OF COLORADO LLC
NPI 1629593967
Social Worker - Clinical in Plainfield, IL

Active since August 08, 2017
10204 BODE ST STE B, PLAINFIELD, IL 60585(855) 241-7160(954) 324-8354 Get Directions Write a Review

NPPES record last updated: September 20, 2019. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Sep 20, 2019, Aug 8, 2017 (2 updates tracked since 2017).

About Blue Moon Of Colorado Llc NPPES

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

BLUE MOON OF COLORADO LLC (NPI 1629593967) is a healthcare organization registered as a clinical in Plainfield, Illinois and active in the NPI registry since August 2017. The organization lists Melanie Donohue, Authorized Official, as its authorized official.

NPPES Registry Identity

NPI1629593967
Entity TypeOrganization
Primary Taxonomy1041C0700X
Legal Business NameBLUE MOON OF COLORADO LLC
Location Address10204 BODE ST STE BPlainfield, IL 60585-9813
Mailing Address10204 Bode St Ste BPlainfield, IL 60585-9813 · (855) 241-7160 · Fax (954) 324-8354
Phone(855) 241-7160
Fax(954) 324-8354
Organization SubpartNo
Authorized OfficialMelanie DonohueAuthorized Official · (702) 403-0438
Enumeration DateAugust 8, 2017
Last NPPES UpdateSeptember 20, 20192 updates tracked since enumeration
✔ NPI 1629593967 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
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.
Also ListedPsychologistTaxonomy 103T00000X
10204 BODE ST STE B, Plainfield, IL 60585
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Blue Moon Of Colorado Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

8

Medicare enrollment records show 8 clinicians reassign Medicare billing to Blue Moon Of Colorado LLC, which bills Medicare for the services they deliver. They are listed nearest first.

Clinicians, nearest first (8)

David Kamis
Clinical Social Worker
NPI 1124493648
29056 FOREST HILL DR
Farmington Hills, MI 48331
(248) 489-0755
✔ PECOS255 mi
Mary Gates, PHD
Mental Health Counselor
NPI 1912131996
18905 E 22 RD
Laverne, OK 73848
(580) 216-3847
✔ PECOS726 mi
Tonya Junod, LCSW
Clinical Social Worker
NPI 1235149444
211 W MAIN ST
Sterling, CO 80751
(970) 522-4549
✔ PECOS783 mi
Kimberly Dunn-Lipscomb, LCSW
Clinical Social Worker
NPI 1467786434
2620 S PARKER RD STE 185
Aurora, CO 80014
(720) 347-8559
✔ PECOS883 mi
Stephen Valente, LCSW
Clinical Social Worker
NPI 1154841054
2465 LANSDOWNE CT.
Highlands Ranch, CO 80126
(303) 968-9308
✔ PECOS✔ Accepts Medicare890 mi
Melissa Hoskins, LCSW
Clinical Social Worker
NPI 1760738777
4851 INDEPENDENCE ST
Wheat Ridge, CO 80033
(303) 425-0300
✔ PECOS893 mi
Bobbie Griffin
Clinical Social Worker
NPI 1790386894
2635 5TH AVE
Pueblo, CO 81003
(719) 302-5500
✔ PECOS899 mi
Karen Vigeland
Clinical Social Worker
NPI 1841938867
4840 48TH ST W APT 606
Bradenton, FL 34210
(941) 224-7674
✔ PECOS1,032 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Blue Moon Of Colorado LLC's NPI number?

The NPI number for Blue Moon Of Colorado LLC is 1629593967. It was assigned to this organization in the NPPES registry on August 8, 2017.

Where is Blue Moon Of Colorado LLC located?

Blue Moon Of Colorado LLC is located at 10204 Bode St Ste B, Plainfield, IL 60585. The listed phone number is (855) 241-7160.

What is Blue Moon Of Colorado LLC's specialty?

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

Is Blue Moon Of Colorado LLC enrolled in Medicare?

Yes. Blue Moon Of Colorado LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Blue Moon Of Colorado LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 8 clinicians in 2 Medicare specialties reassign their Medicare billing to Blue Moon Of Colorado LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Clinical Social Worker (7) and Mental Health Counselor (1). Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Blue Moon Of Colorado LLC was last updated on September 20, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.