Active NPI
Doris M Van Byssum I, PSY.D.
- Psychiatric/Mental Health Nurse Practitioner
- Wheaton, IL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- 209.010527041.189584
- Practice address
- 1725 S Naperville Rd
Suite 206
Wheaton, IL 60189-5805 - Phone
- (630) 653-6441
- Fax
- (630) 653-8409
- NPI assigned
- Sep 6, 2006
- Sex
- Female
- Sole proprietor
- No
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 | 071-004744 | IL | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 209.010527041.189584 | IL | Primary |
Addresses
Primary practice location
1725 S Naperville Rd
Suite 206
Wheaton, IL 60189-5805
Mailing address
174 S Montclair Ave
Glen Ellyn, IL 60137-6357
Phone (630) 858-0875
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: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 1982
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
1725 S Naperville Rd
Wheaton, IL 60189-5855
Phone (630) 653-6441
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071-004744 | IL | MD | Clinical Psychologist |
| 209.010527041.189584 | IL | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Genesis Clinical Services | Current | Accepting new patients | |
| Fox Valley Institute for Growth and Wellness Inc | Current | Accepting new patients |
Locations
640 N River Rd
Ste 108
Naperville, IL 60563
Phone (630) 359-8951
1725 S Naperville Rd
Ste 206
Wheaton, IL 60189
Phone (630) 653-6441
1725 S Naperville Rd
Ste 2
Wheaton, IL 60189
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 and National Provider Directory roles.
-
- Multi-Specialty Clinic/Center
- Wheaton, IL
- NPI 1265432140
-
- Counselor
- Naperville, IL
- NPI 1174637334
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1489449600000",
"number": "1063515369",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "174 S MONTCLAIR AVE",
"city": "GLEN ELLYN",
"state": "IL",
"postal_code": "601376357",
"telephone_number": "630-858-0875",
"fax_number": "630-858-0650"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1725 S NAPERVILLE RD",
"address_2": "SUITE 206",
"city": "WHEATON",
"state": "IL",
"postal_code": "601895805",
"telephone_number": "630-653-6441",
"fax_number": "630-653-8409"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN BYSSUM",
"first_name": "DORIS",
"middle_name": "M",
"name_suffix": "I",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-06",
"last_updated": "2017-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071-004744",
"primary": false
},
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "IL",
"license": "209.010527041.189584",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Wheaton, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2017; 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.