Individual provider Active NPI

Andrea Kristin Busby, PH.D.

  • Clinical Psychologist
  • Evanston, IL
National Provider Identifier
1124393129
Registry record updated Sep 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071009082 Issued in IL
Practice address
909 Davis St Ste 160
Evanston, IL 60201-3664
Phone
(847) 425-6400
Fax
(847) 425-6408
NPI assigned
Mar 9, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2022

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 071009082 IL Primary

Addresses

Primary practice location

909 Davis St Ste 160
Evanston, IL 60201-3664

Mailing address

909 Davis St Ste 160
Evanston, IL 60201-3664
Phone (847) 425-6400

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151008002038 IL Practitioner - Clinical Psychologist 9335396811 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Ohio State University College of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Endeavor Health Medical GroupGroup PAC ID 2163334699, 3,330 clinicians

Practice addresses (Care Compare)

2650 Ridge Ave
Evanston, IL 60201-1700

Hospital & facility affiliations

  • Northshore University Healthsystem - Evanston Hospital Hospital, Evanston, IL, CCN 140010

Merit-based Incentive Payment System (MIPS)

Final score
84.9 of 100Reported as group
Quality
75.91
Promoting interoperability
99
Improvement activities
40
Cost
74.6

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
071009082ILMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Endeavor Health Medical Group CurrentSince Sep 25, 2022 Accepting new patients
Endeavor Health Medical Group CurrentSince Aug 30, 2022 Accepting new patients
Endeavor Health Clinical Operations PastSince Sep 25, 2022 Accepting new patients

Locations

9532 Eagle Way
Chicago, IL 60678

2650 Ridge Ave
Ste 1223
Evanston, IL 60201
Phone (847) 982-3175

909 Davis St
Ste 160
Evanston, IL 60201
Phone (847) 425-6425

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1331251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663545600000",
    "number": "1124393129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 DAVIS ST STE 160",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602013664",
            "telephone_number": "847-425-6400",
            "fax_number": "847-425-6408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 DAVIS ST STE 160",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602013664",
            "telephone_number": "847-425-6400",
            "fax_number": "847-425-6408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSBY",
        "first_name": "ANDREA",
        "middle_name": "KRISTIN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-09",
        "last_updated": "2022-09-19",
        "certification_date": "2022-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071009082",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evanston, IL

Sources for this page

Verify at the official NPI Registry.