Active NPI
Kenneth R Crossman, PHD(C)
- Psychologist
- Oak Park, IL
National Provider Identifier
1063654002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 180-003154
- Practice address
- 137 N Oak Park Ave
Suite 400
Oak Park, IL 60301-1344 - Phone
- (708) 386-9690
- NPI assigned
- Apr 6, 2009
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 180-003154 | IL | |
| Psychologist | 103T00000X | 180-003154 | IL | Primary |
Addresses
Primary practice location
137 N Oak Park Ave
Suite 400
Oak Park, IL 60301-1344
Mailing address
137 N Oak Park Ave
Suite 400
Oak Park, IL 60301-1344
Phone (708) 386-9690
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 21, 2024 through Mar 21, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180-003154 | IL | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Integrative Psychotherapy Associates, LLC | Mental Health | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Mental Health Counselor
- Oak Park, IL
- NPI 1154659068
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1238976000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1238976000000",
"number": "1063654002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "137 N OAK PARK AVE",
"address_2": "SUITE 400",
"city": "OAK PARK",
"state": "IL",
"postal_code": "603011344",
"telephone_number": "708-386-9690"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "137 N OAK PARK AVE",
"address_2": "SUITE 400",
"city": "OAK PARK",
"state": "IL",
"postal_code": "603011344",
"telephone_number": "708-386-9690"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CROSSMAN",
"first_name": "KENNETH",
"middle_name": "R",
"credential": "PHD(C)",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-04-06",
"last_updated": "2009-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IL",
"license": "180-003154",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "IL",
"license": "180-003154",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oak Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2009; 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.