Individual provider Active NPI

Byron Desalvio Brooks, PHD

  • Clinical Psychologist
  • Chicago, IL
National Provider Identifier
1124883517
Registry record updated Feb 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071010958 Issued in IL
Practice address
1642 E 56TH St Apt 617
Chicago, IL 60637-1974
Phone
(864) 561-4723
NPI assigned
Feb 15, 2024
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 15, 2024

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 071010958 IL Primary

Addresses

Primary practice location

1642 E 56TH St Apt 617
Chicago, IL 60637-1974

Mailing address

1642 E 56TH St Apt 617
Chicago, IL 60637-1974
Phone (864) 561-4723

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
I20240409004530 IL Practitioner - Clinical Psychologist 8820436868 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Board of Trustees of the University of IllinoisGroup PAC ID 3072422716, shared by 24 NPIs, 1,134 clinicians
Endeavor Health Medical GroupGroup PAC ID 2163334699, 3,330 clinicians

Practice addresses (Care Compare)

1220 S Wood St
Chicago, IL 60608-1202
Phone (312) 413-3282

2650 Ridge Ave
Evanston, IL 60201-1700

722 W Maxwell St
Suite 235
Chicago, IL 60607-5002
Phone (312) 433-4114

Hospital & facility affiliations

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

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
071010958ILMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Erie Family Health Center Inc CurrentSince Jan 6, 2025 Accepting new patients
The Board of Trustees of the University of Illinois CurrentSince Feb 11, 2025 Accepting new patients
Erie Family Health Center Inc CurrentSince Jan 6, 2025 Accepting new patients
Erie Family Health Center, Inc Current Accepting new patients
The Board of Trustees of the University of Illinois CurrentSince Feb 11, 2025 Accepting new patients
Endeavor Health Medical Group Current Accepting new patients
Endeavor Health Medical Group CurrentSince Mar 27, 2024 Accepting new patients

Locations

1220 S Wood St
Chicago, IL 60608
Phone (312) 413-1261

1504 S Albany Ave
Chicago, IL 60623

9532 Eagle Way
Chicago, IL 60678

7732 Solution Ctr
Chicago, IL 60677
Phone (312) 355-6290

912 S Wood St
Chicago, IL 60612
Phone (312) 996-2200

1701 W Superior St
Fl 3
Chicago, IL 60622
Phone (312) 432-7381

1701 W Superior St
Fl 2
Chicago, IL 60622
Phone (323) 361-2122

722 W Maxwell St
#235
Chicago, IL 60607
Phone (312) 433-4114

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

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

Organizations & group practices 9

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": "1707955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707955200000",
    "number": "1124883517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1642 E 56TH ST APT 617",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606371974",
            "telephone_number": "864-561-4723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1642 E 56TH ST APT 617",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606371974",
            "telephone_number": "864-561-4723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROOKS",
        "first_name": "BYRON",
        "middle_name": "DESALVIO",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-02-15",
        "last_updated": "2024-02-15",
        "certification_date": "2024-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071010958",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.