Jie Jiao, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071008880 Issued in IL

Practice address

5901 N Prospect Rd Ste 202
Peoria, IL 61614-4358

Phone

(888) 428-7890

Fax

(877) 428-7890

NPI assigned

Aug 13, 2014

Sex

Female

Sole proprietor

Yes

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

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

Specialty

Clinical Psychologist

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Edgewood Clinical Services P.C.Group PAC ID 3971963901, 304 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lifestancehealth.jiejiao@146897.advancedmd-direct.com

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

• Edgewood Clinical Services, P.C.

  dba LifeStance

  • Psychologist
  • Naperville, IL
  • NPI 1295914646
  Medicare reassignment Care Compare group NPD
• Siebert Moazzam P C

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Peoria, IL
  • NPI 1396780292
  NPD

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

{
    "created_epoch": "1407888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690416000000",
    "number": "1053720284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5901 N PROSPECT RD STE 202",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144358",
            "telephone_number": "888-428-7890",
            "fax_number": "877-428-7891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5901 N PROSPECT RD STE 202",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144358",
            "telephone_number": "888-428-7890",
            "fax_number": "877-428-7890"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2205 State St",
            "address_purpose": "LOCATION",
            "city": "Pekin",
            "state": "IL",
            "postal_code": "615543936",
            "country_code": "US",
            "telephone_number": "888-428-7890",
            "fax_number": "877-428-7891",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JIAO",
        "first_name": "JIE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-08-13",
        "last_updated": "2023-07-27",
        "certification_date": "2023-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071008880",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Josie Cathryn Jepson, PA
• Traci M Jeske, DEVL THERAPIST
• Jason Jesse
• Cyndi Jewell-Miller, OTR/L
• Laurence Jiang, M.D.
• Anna Jijo
• Jody L. Kelly M.D. & Associates, LLC (Jody L. Kelly M.D. & Associates, LLC - North)
• John B. Dale, DMD, Ms, P.C.
• John C. Proctor Endowment
• John Day & Associates, LTD

• Clinical Psychologist in Peoria, IL
• Providers in Peoria, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.