Individual provider Active NPI

Arthur Jacek Krzyzanowski, PSY.D.

  • Clinical Psychologist
  • Chicago, IL
National Provider Identifier
1043442643
Registry record updated Aug 14, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071.006531 Issued in IL
Practice address
4101 N Ravenswood Ave
Chicago, IL 60613-2193
Phone
(773) 572-5449
Fax
(773) 537-3455
NPI assigned
Aug 14, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 14, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 071.006531 IL Primary

Addresses

Primary practice location

4101 N Ravenswood Ave
Chicago, IL 60613-2193

Mailing address

4101 N Ravenswood Ave
Chicago, IL 60613-2193
Phone (773) 572-5449

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260526000857 IL Practitioner - Clinical Psychologist 8426528068 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2000
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

3701 Doty Rd
Woodstock, IL 60098-7550

5777 Dept
Carol Stream, IL 60122-0021

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
071.006531ILMDClinical Psychologist

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1250208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1250208000000",
    "number": "1043442643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4101 N RAVENSWOOD AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606132193",
            "telephone_number": "773-572-5449",
            "fax_number": "773-537-3455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4101 N RAVENSWOOD AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606132193",
            "telephone_number": "773-572-5449",
            "fax_number": "773-537-3455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRZYZANOWSKI",
        "first_name": "ARTHUR",
        "middle_name": "JACEK",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-08-14",
        "last_updated": "2009-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.006531",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.