Poorva Talapatra, M.ED., LCPC
Individual provider Active NPI Mental Health Counselor · Carbondale, IL
NPI 1013210194 · NPPES record last updated Aug 25, 2015
Key facts
- NPI
- 1013210194
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 178005097 (IL)
- Practice address
- 400 S Lewis LN
Carbondale, IL 62901-3547 - Phone
- (618) 519-9900
- Fax
- (618) 529-1384
- NPI assigned
- Dec 13, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Ahuja Bariatric and Beyond
Practice addresses (Care Compare)
4230 Lincolnshire Dr
Suite a
Mount Vernon, IL 62864-2189
Phone (618) 315-6466
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240213001574 | IL | Practitioner - Mental Health Counselor | 1355784794 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178005097 | IL | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shawnee Health Service and Development Corp | Mental Health | Current |
Accepting new patients |
| Ahuja Bariatric & Beyond | Current |
Accepting new patients | |
| Shawnee Health Service and Development Corp | Current |
Accepting new patients | |
| Shawnee Health Service and Development Corp | Current | Accepting new patients | |
| Shawnee Health Service and Development Corp | Mental Health | Past | Accepting new patients |
Locations
400 S Lewis Ln
Carbondale, IL 62901
Phone (618) 519-9900
6355 Brandhorst Rd
Carterville, IL 62918
1006 S Division St
Carterville, IL 62918
Phone (618) 985-4841
3020 S Park Ave
Herrin, IL 62948
Phone (618) 315-6466
4230 Lincolnshire Dr
Ste A
Mount Vernon, IL 62864
Phone (618) 244-6222
Interoperability endpoints
- poorva.talapatra.1@14668.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 178005097 | IL | Yes |
Addresses
Primary practice location
400 S Lewis LN
Carbondale, IL 62901-3547
Mailing address
PO Box 577
109 California St
Carterville, IL 62918-0577
Phone (618) 985-8221
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 370966854024 | Medicaid | IL |
Other providers in Carbondale, IL
- Sohaib Hasan Syed
- Synapse Collaborative LLC
- Synapse Mental Health PLLC
- Synergy Therapeutic Group
- Erin Szynkowski
- Terri Tate
- Emoni Tatum
- Melba Margaret Taylor
- Victoria Faith Taylor
- Salem Najeh Thabet
All providers in Carbondale, IL · Mental Health Counselor in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 25, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.