Individual provider Active NPI

Jamie Martin, PSYD

  • Clinical Psychologist
  • Chicago, IL
National Provider Identifier
1114079324
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Practice address
1731 N Marcey
Suite 535
Chicago, IL 60614
Phone
(312) 280-1166
Fax
(312) 280-1199
NPI assigned
Jan 17, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X IL Primary

Addresses

Primary practice location

1731 N Marcey
Suite 535
Chicago, IL 60614

Mailing address

1731 N Marcey
Suite 535 Terry Hefter Associates LLC
Chicago, IL 60614
Phone (312) 280-1166

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
071006610ILMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Terry Hefter Associates LLC PastSince Jan 1, 2010 Accepting new patients
Davken Associates, P.C. Clinical Past Accepting new patients
Aspen Behavioral Care Clinical PastSince Jul 31, 2013 Accepting new patients

Organizations & group practices 3

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": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1114079324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1731 N MARCEY",
            "address_2": "SUITE 535 TERRY HEFTER ASSOCIATES LLC",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60614",
            "telephone_number": "312-280-1166",
            "fax_number": "312-280-1199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1731 N MARCEY",
            "address_2": "SUITE 535",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60614",
            "telephone_number": "312-280-1166",
            "fax_number": "312-280-1199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "JAMIE",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": null,
            "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 Jul 8, 2007; 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.