NPIMap

Organization Active NPI

Board of Trustees of the University of Illinois

  • Psychologist
  • Champaign, IL
National Provider Identifier
1104401454
Registry record updated Mar 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Practice address
301 N Neil St Ste 210
Champaign, IL 61820-3166
Phone
(217) 244-4597
NPI assigned
Mar 17, 2021
Organization subpart
Yes
Parent organization
BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOISAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 17, 2021

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

Authorized official

Name
Dr. Avijit Ghosh
Title
Comptroller
Phone
(217) 333-1202

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X Primary

Addresses

Primary practice location

301 N Neil St Ste 210
Champaign, IL 61820-3166

Mailing address

603 East Daniel Street
Room 327, Brenda Reinhold
Champaign, IL 61820
Phone (217) 244-4613

National Provider Directory

National Provider Directory
Tax ID family
Univ of Illinois Hospit122 organizations share this tax ID, including this one
Part of
Univ of Illinois Hospit

Organizations with this tax ID in the same state 18

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 18

Locations

603 E Daniel St
Rm 327
Champaign, IL 61820

301 N Neil St
Ste 210
Champaign, IL 61820
Phone (217) 244-4597

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1615939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615939200000",
    "number": "1104401454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 EAST DANIEL STREET",
            "address_2": "ROOM 327, BRENDA REINHOLD",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "61820",
            "telephone_number": "217-244-4613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 N NEIL ST STE 210",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618203166",
            "telephone_number": "217-244-4597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS",
        "enumeration_date": "2021-03-17",
        "last_updated": "2021-03-17",
        "certification_date": "2021-03-17",
        "status": "A",
        "authorized_official_last_name": "GHOSH",
        "authorized_official_first_name": "AVIJIT",
        "authorized_official_title_or_position": "COMPTROLLER",
        "authorized_official_telephone_number": "217-333-1202",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Champaign, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.