Active NPI
Ronald J Ganellen, PHD
- Clinical Psychologist
- Chicago, IL
National Provider Identifier
1073568457
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071003236
- Practice address
- 405 N Wabash
Suite 2810 Ronald J Ganellen PHD
Chicago, IL 60611 - Phone
- (312) 822-7255
- Fax
- (312) 822-9051
- NPI assigned
- May 23, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 071003236 | IL | Primary |
Addresses
Primary practice location
405 N Wabash
Suite 2810 Ronald J Ganellen PHD
Chicago, IL 60611
Mailing address
405 N Wabash
Suite 2810 Ronald J Ganellen PHD
Chicago, IL 60611
Phone (312) 822-7255
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20121231000174 | IL | Practitioner - Clinical Psychologist | 0042463986 | Practice locations: Chicago, IL |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1983
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
405 N Wabash Ave
Unit 2810
Chicago, IL 60611-5672
Phone (312) 822-7255
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071003236 | IL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148342400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1203638400000",
"number": "1073568457",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "405 N WABASH",
"address_2": "SUITE 2810 RONALD J GANELLEN PHD",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60611",
"telephone_number": "312-822-7255",
"fax_number": "312-822-9051"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "405 N WABASH",
"address_2": "SUITE 2810 RONALD J GANELLEN PHD",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60611",
"telephone_number": "312-822-7255",
"fax_number": "312-822-9051"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GANELLEN",
"first_name": "RONALD",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-23",
"last_updated": "2008-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071003236",
"primary": true
}
],
"identifiers": [],
"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 Feb 22, 2008; 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.