MR. PAUL D JR. EVERETT – Mental Health Counselor, NPI 1053654756

MR. PAUL D JR. EVERETT is a healthcare provider. based in Chicago, Illinois. specializing in CLINICAL SOCIAL WORKER. They hold a License No. 149015589 (IL). The NPI Number for MR. PAUL D JR. EVERETT is 1053654756

Main info

Male
Sole Proprietor
17 Years Of Experience
Accepts Medicare Assignment
Name
MR. PAUL D JR. EVERETT
NPI
1053654756
Phone
(773) 879-0536
Address
5524 W HARRISON ST
Enumeration Date
1 April 2013
Last Update Date
24 February 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7089604023
Graduation Year
2009 (17 years ago)
PAC ID
2163665019
Group Practice PAC ID
6800037771
Professional Enrollment ID
I20130826000609
Address ID
IL604679493OR11536PLXX300
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience55
Completeness75
Years active:13State licenses:1Digital endpointsOther names

3,510 CLINICAL SOCIAL WORKER in IL

Provider Addresses for MR. PAUL D JR. EVERETT

  • 5524 W HARRISON ST

    CHICAGO, IL 606445032

    Phone: (773) 879-0536

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2013-08-26

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20130826000609IClinical Social WorkerILTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 60644)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 6800037771View full group profile
NameSpecialtyState
Clinical Social WorkerIN
Clinical Social WorkerIL
Clinical Social WorkerIL

Reviews

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Frequently asked questions

What federal number belongs to MR. PAUL D JR. EVERETT?
The federal identifier for MR. PAUL D JR. EVERETT is NPI 1053654756.
Is MR. PAUL D JR. EVERETT's enrollment marked active?
An active flag here means the NPI record is not in a deactivated state.
Does MR. PAUL D JR. EVERETT list a primary specialty?
If you are matching referrals, note Mental Health Counselor for MR. PAUL D JR. EVERETT. Clinical services aligned with this taxonomy classification.
What location shows for MR. PAUL D JR. EVERETT?
We surface Chicago, Illinois for MR. PAUL D JR. EVERETT based on available NPPES addresses.
What if Chicago, Illinois seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

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