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MR. JEROME PIETRUSIAK LICENSED CLINICAL SO
NPI 1679793913
Social Worker - Clinical in Chicago, IL

Active since April 27, 2007PECOS EnrolledAccepts Medicare Assignment
3456 W FRANKLIN BLVD, CHICAGO, IL 60624(773) 533-6013 Get Directions Write a Review

NPPES record last updated: December 26, 2019. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Dec 26, 2019, Jun 21, 2016 (2 updates tracked since 2016).

About Mr. Jerome Pietrusiak Licensed Clinical So NPPES

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

MR. JEROME PIETRUSIAK LICENSED CLINICAL SO (NPI 1679793913) is an individual clinical provider in Chicago, Illinois, licensed in Illinois (149.002241) and active in the NPI registry since April 2007. He is enrolled in Medicare PECOS and is a graduate of Other (1983).

NPPES Registry Identity

NPI1679793913
Entity TypeIndividualMale
Primary Taxonomy1041C0700X
Provider Legal NameMR. JEROME PIETRUSIAKCredential: LICENSED CLINICAL SO
Location Address3456 W FRANKLIN BLVDChicago, IL 60624-1308
Mailing Address2105 SunnysideWestchester, IL 60154-5205 · (708) 562-9070 · Fax (708) 562-9073
Phone(773) 533-6013
Sole ProprietorNo
Medical School CMSOtherGraduated 1983
Enumeration DateApril 27, 2007
Last NPPES UpdateDecember 26, 20192 updates tracked since enumeration
✔ NPI 1679793913 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
License✔ Licensed in IL · 149.002241
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 ListedSocial WorkerTaxonomy 104100000X · License 149002241 (IL)
3456 W FRANKLIN BLVD, Chicago, IL 60624
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mr. Jerome Pietrusiak Licensed Clinical So is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID5799078499
PECOS Enrollment IDI20160718001800
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Jerome Pietrusiak reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Pcc Community Wellness Center
3.2 mi
Federally Qualified Health Center (FQHC)
14 LAKE ST
Oak Park, IL 60302
  • Reassigned Medicare billing, Illinois enrollment
  • 221 clinicians in this Medicare group
NPI 1871516799 (708) 383-0113

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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 60624 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$0.00 typical visit price
range $60.08 – $183.39
Typical copayment $0.00 (range $15.02 – $45.84)
Most-billed visit code NA
Established Patient
$74.80 typical visit price
range $18.97 – $148.12
Typical copayment $18.70 (range $4.74 – $37.03)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 3

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

THE BOULEVARD OF CHICAGO
Clinic/Center (Adult Mental Health)
3456 W FRANKLIN BLVD
CHICAGO, IL 60624
Cook County (630) 903-3331
THE BOULEVARD OF CHICAGO
Respite Care
3456 W FRANKLIN BLVD
CHICAGO, IL 60624
Cook County (773) 533-6013
PCC COMMUNITY WELLNESS CENTER
Clinic/Center (Federally Qualified Health Center (FQHC))
3456 W FRANKLIN BLVD
CHICAGO, IL 60624
Cook County (773) 533-3107

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 Jerome Pietrusiak's NPI number?

The NPI number for Jerome Pietrusiak is 1679793913. It was assigned to this individual provider in the NPPES registry on April 27, 2007.

Where is Jerome Pietrusiak located?

Jerome Pietrusiak practices at 3456 W Franklin Blvd, Chicago, IL 60624. The listed phone number is (773) 533-6013.

What is Jerome Pietrusiak's specialty?

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

Is Jerome Pietrusiak enrolled in Medicare?

Yes. Jerome Pietrusiak is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Jerome Pietrusiak's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jerome Pietrusiak reassigns Medicare benefits to Pcc Community Wellness Center (Oak Park, IL). The 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 Jerome Pietrusiak's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Jerome Pietrusiak was last updated on December 26, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.