Luis San Roman, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

18012203 Issued in IL

Practice address

100 N Waukegan Rd Ste 204
Lake Bluff, IL 60044-1660

Phone

(847) 821-9346

NPI assigned

Mar 24, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Specialty

Mental Health Counselor

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

White Stone Partners LLCGroup PAC ID 2163873803, 7 clinicians

Mosaic Wholeness Center LLCGroup PAC ID 2163918723, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Mosaic Wholeness Center LLC

  • Professional Counselor
  • Rolling Meadows, IL
  • NPI 1245110782
  Medicare reassignment Care Compare group NPD Authorized official
• White Stone Partners LLC

  • Professional Counselor
  • Lake Bluff, IL
  • NPI 1801543616
  Medicare reassignment Care Compare group NPD
• White Stone Resources LTD.

  • Professional Counselor
  • Palatine, IL
  • NPI 1124159124
  NPD (past)

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

{
    "created_epoch": "1458777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659657600000",
    "number": "1124480595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N WAUKEGAN RD STE 204",
            "city": "LAKE BLUFF",
            "state": "IL",
            "postal_code": "600441660",
            "telephone_number": "847-821-9346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N WAUKEGAN RD STE 204",
            "city": "LAKE BLUFF",
            "state": "IL",
            "postal_code": "600441660",
            "telephone_number": "847-821-9346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAN ROMAN",
        "first_name": "LUIS",
        "name_prefix": "Dr.",
        "credential": "LCPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-03-24",
        "last_updated": "2022-08-05",
        "certification_date": "2022-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "178011862",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "18012203",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ivana F. Ruffolo, M.D.
• Alexandra Salaiza
• Angel J Salgado, RBT
• Danielle Renee Salgado
• Linda R Salmon, DDS
• Ricardo Sandoval, RBT
• Rachel Hoying Santoro, MD
• Scheck & Siress Prosthetics, Inc
• Rachel Anne Schultz, MS, LCSW, CADC
• Richard Edwin Schultz, DC

• Professional Counselor in Lake Bluff, IL
• Providers in Lake Bluff, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2022; 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.

Verify at the official NPI Registry.