Individual provider Active NPI

Marc Drummond, PSY.D.

  • Clinical Psychologist
  • Aurora, IL
National Provider Identifier
1104923408
Registry record updated Dec 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071008271 Issued in IL
Practice address
1700 N Farnsworth Ave
Suite 12
Aurora, IL 60505-1523
Phone
(630) 851-6100
Fax
(630) 851-6154
NPI assigned
Sep 20, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 12, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 180003279 IL
Clinical Psychologist 103TC0700X 071008271 IL Primary

Addresses

Primary practice location

1700 N Farnsworth Ave
Suite 12
Aurora, IL 60505-1523

Mailing address

314 Flintlock CT
Oswego, IL 60543-8770
Phone (630) 301-0658

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
180003279ILMDProfessional Counselor
071008271ILMDClinical Psychologist

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323648000000",
    "number": "1104923408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 FLINTLOCK CT",
            "city": "OSWEGO",
            "state": "IL",
            "postal_code": "605438770",
            "telephone_number": "630-301-0658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 N FARNSWORTH AVE",
            "address_2": "SUITE 12",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605051523",
            "telephone_number": "630-851-6100",
            "fax_number": "630-851-6154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DRUMMOND",
        "first_name": "MARC",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2011-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180003279",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071008271",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aurora, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2011; 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.