Individual provider Active NPI

Doris M Van Byssum I, PSY.D.

  • Psychiatric/Mental Health Nurse Practitioner
  • Wheaton, IL
National Provider Identifier
1063515369
Registry record updated Mar 14, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
209.010527041.189584 Issued in IL
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

Updated by the provider on Mar 14, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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 IL2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20071005000458 IL Practitioner - Clinical Psychologist 9931294931 Reassigns benefits to 1 organization
I20160210001934 IL Practitioner - Nurse Practitioner 9931294931 Reassigns benefits to 1 organization

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
Genesis Clinical ServicesGroup PAC ID 9739153347, 15 clinicians

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

LicenseStateTypeSpecialty
071-004744ILMDClinical Psychologist
209.010527041.189584ILMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Genesis Clinical Services CurrentSince Jun 11, 2015 Accepting new patients
Fox Valley Institute for Growth and Wellness Inc CurrentSince Oct 11, 2023 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.

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

Verify at the official NPI Registry.