Individual provider Active NPI

Timothy R. Buhrt, PSY.D.

  • Clinical Psychologist
  • St Charles, IL
National Provider Identifier
1063408250
Registry record updated Mar 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071005828 Issued in IL
Practice address
1120 E Main St Ste 201
St Charles, IL 60174-2287
Phone
(630) 377-6613
Fax
(630) 377-6225
NPI assigned
Sep 22, 2005
Last updated
Mar 4, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2024

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 071005828 IL Primary

Addresses

Primary practice location

1120 E Main St Ste 201
St Charles, IL 60174-2287

Mailing address

1120 E Main St
Ste. 201
St Charles, IL 60174-2287
Phone (630) 377-6613

Other identifiers 1

IdentifierTypeStateIssuer
364333972OtherILTAX IDENTIFICATION NUMBER

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
I20070206000226 IL Practitioner - Clinical Psychologist 4385646272 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Centennial Counseling Center, PCGroup PAC ID 7416959390, 26 clinicians

Practice addresses (Care Compare)

1120 E Main St
Suite 201
St Charles, IL 60174-2287
Phone (630) 377-6613

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
071005828ILMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Centennial Counseling Center, PC CurrentSince Feb 1, 2007 Accepting new patients
Edward Health Ventures Past Accepting new patients

Locations

207 E Church St
Unit A
Sandwich, IL 60548
Phone (815) 786-8606

1120 E Main St
Ste 201
St Charles, IL 60174
Phone (630) 377-6613

110 E Countryside Pkwy
Ste C
Yorkville, IL 60560
Phone (630) 553-1600

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1127347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709510400000",
    "number": "1063408250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 E MAIN ST",
            "address_2": "STE. 201",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601742287",
            "telephone_number": "630-377-6613",
            "fax_number": "630-377-6225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 E MAIN ST STE 201",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601742287",
            "telephone_number": "630-377-6613",
            "fax_number": "630-377-6225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUHRT",
        "first_name": "TIMOTHY",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-22",
        "last_updated": "2024-03-04",
        "certification_date": "2024-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071005828",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX IDENTIFICATION NUMBER",
            "identifier": "364333972",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Charles, IL

Sources for this page

Verify at the official NPI Registry.