Active NPI
Paul Pasulka, PH.D.
- Clinical Neuropsychologist
- Chicago, IL
National Provider Identifier
1063504124
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- 071-003338
- Practice address
- 600 N McClurg CT
Suite 3803a
Chicago, IL 60611-3044 - Phone
- (312) 266-2136
- Fax
- (312) 266-6375
- NPI assigned
- Sep 28, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | 071-003338 | IL | Primary |
| Psychologist | 103T00000X | 071-003338 | IL | |
| Clinical Psychologist | 103TC0700X | 071-003338 | IL | |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 071-003338 | IL | |
| Forensic Psychologist | 103TF0200X | 071-003338 | IL |
Addresses
Primary practice location
600 N McClurg CT
Suite 3803a
Chicago, IL 60611-3044
Mailing address
600 N McClurg CT
Suite 3803a
Chicago, IL 60611-3044
Phone (312) 266-2136
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01673053 | Other | IL | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071-003338 | IL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1286841600000",
"number": "1063504124",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 N MCCLURG CT",
"address_2": "SUITE 3803A",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606113044",
"telephone_number": "312-266-2136",
"fax_number": "312-266-6375"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 N MCCLURG CT",
"address_2": "SUITE 3803A",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606113044",
"telephone_number": "312-266-2136",
"fax_number": "312-266-6375"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PASULKA",
"first_name": "PAUL",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-28",
"last_updated": "2010-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "IL",
"license": "071-003338",
"primary": true
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "IL",
"license": "071-003338",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071-003338",
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "IL",
"license": "071-003338",
"primary": false
},
{
"code": "103TF0200X",
"taxonomy_group": "",
"desc": "Psychologist, Forensic",
"state": "IL",
"license": "071-003338",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "01673053",
"state": "IL"
}
],
"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 Oct 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.