MEDICARE: PROMETHEUS RISES PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1043174824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROMETHEUS RISES PLLC

Provider Business Mailing Address
First Line	:	2501 CHATHAM RD STE N
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-4188
Country	:	US
Telephone Number	:	314-328-0955
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 CHATHAM RD STE N
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-4188
Country	:	US
Telephone Number	:	210-874-8949
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	JUSTIN L MCKEVITT
Credential	:	LCSW
Telephone Number	:	314-328-0955

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	04/08/2026

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