Angel Heredia, MD

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

036078873 Issued in IL

Practice address

1541 E Fabyan Pkwy Ste 101
Geneva, IL 60134-4105

Phone

(630) 845-9644

Fax

(630) 845-9678

NPI assigned

Nov 16, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Plains Clinic

  • Child & Adolescent Psychiatry Physician
  • Geneva, IL
  • NPI 1215652011
  NPD
• Summit Clinical Services PC

  • Counselor
  • Wheaton, IL
  • NPI 1518082502
  NPD (past)
• The Prairie Clinic

  • Clinical Child & Adolescent Psychologist
  • Geneva, IL
  • NPI 1184863847
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675209600000",
    "number": "1023181070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1541 E FABYAN PKWY STE 101",
            "city": "GENEVA",
            "state": "IL",
            "postal_code": "601344105",
            "telephone_number": "630-845-9644",
            "fax_number": "630-260-1049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1541 E FABYAN PKWY STE 101",
            "city": "GENEVA",
            "state": "IL",
            "postal_code": "601344105",
            "telephone_number": "630-845-9644",
            "fax_number": "630-845-9678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEREDIA",
        "first_name": "ANGEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-16",
        "last_updated": "2023-02-01",
        "certification_date": "2023-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "IL",
            "license": "036078873",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hearthstone Psychological Services PC
• Jennifer Hein
• Scott Whitney Helm, M.D
• Catherine V Hendricks, LCSW
• Morgan Henson, RBT
• Tyler Herrod
• Charles F Hewell, M.D
• Maryann Hewiyou
• Kelly Hickley, RBT
• Highland Park CVS, L.L.C. (CVS Pharmacy # 04269)

• Child & Adolescent Psychiatry Physician in Geneva, IL
• Providers in Geneva, IL by specialty
• Child & Adolescent Psychiatry Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.