NPIMap

Organization Active NPI

Alliance Clinical Associates SC

  • Psychiatry Physician
  • Wheaton, IL
National Provider Identifier
1144299769
Registry record updated Aug 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
ALLIANCE CLINICAL ASSOCIATES SC
Practice address
7 Blanchard Cir
Suite 201
Wheaton, IL 60189-2039
Phone
(630) 653-2300
Fax
(630) 653-2895
NPI assigned
Mar 16, 2006
Last updated
Aug 23, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2010

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

Authorized official

Name
Dr. Kenneth P Phillips, MDNPI 1538138748
Title
President
Phone
(630) 653-2300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X NU
Clinical Psychologist 103TC0700X NU
Clinical Social Worker 1041C0700X NU
Psychiatry Physician 2084P0800X NU Primary

Addresses

Primary practice location

7 Blanchard Cir
Suite 201
Wheaton, IL 60189-2039

Mailing address

7 Blanchard Cir
Suite 201
Wheaton, IL 60189-2039
Phone (630) 653-2300

Other identifiers 1

IdentifierTypeStateIssuer
02215643OtherILBLUE CROSS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040805000281 IL Part B Supplier - Clinic/Group Practice 0143202572 Receives reassigned benefits from 20 practitioners
Practice locations: Wheaton, IL

National Provider Directory

National Provider Directory

Locations

7 Blanchard Cir
Ste 201
Wheaton, IL 60189
Phone (630) 653-2300

Practitioners & affiliated clinicians

Practitioners 46

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 46

NPI Registry JSON

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

{
    "created_epoch": "1142467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282521600000",
    "number": "1144299769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 BLANCHARD CIR",
            "address_2": "SUITE 201",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601892039",
            "telephone_number": "630-653-2300",
            "fax_number": "630-653-2895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 BLANCHARD CIR",
            "address_2": "SUITE 201",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601892039",
            "telephone_number": "630-653-2300",
            "fax_number": "630-653-2895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLIANCE CLINICAL ASSOCIATES SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-16",
        "last_updated": "2010-08-23",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-653-2300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "02215643",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wheaton, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.