Active NPI
Gregory Clement Concodora, PSYD
- Clinical Psychologist
- Chicago, IL
National Provider Identifier
1053846881
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071009527
- Practice address
- 5100 N Ravenswood Ave
Suite 238
Chicago, IL 60640-1710 - Phone
- (718) 483-4841
- NPI assigned
- Apr 30, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 071009527 | IL | Primary |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 071009527 | IL |
Addresses
Primary practice location
5100 N Ravenswood Ave
Suite 238
Chicago, IL 60640-1710
Mailing address
5100 N Ravenswood Ave
Suite 238
Chicago, IL 60640-1710
Phone (718) 483-4841
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 15, 2021 through Nov 15, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071009527 | IL | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1493510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1493510400000",
"number": "1053846881",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5100 N RAVENSWOOD AVE",
"address_2": "SUITE 238",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606401710",
"telephone_number": "718-483-4841"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5100 N RAVENSWOOD AVE",
"address_2": "SUITE 238",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606401710",
"telephone_number": "718-483-4841"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONCODORA",
"first_name": "GREGORY",
"middle_name": "CLEMENT",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-04-30",
"last_updated": "2017-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071009527",
"primary": true
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "IL",
"license": "071009527",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.