Individual provider Active NPI

Joseph Michael Roszkowski, PSY.D.

  • Clinical Psychologist
  • Winfield, IL
National Provider Identifier
1144352626
Registry record updated Feb 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
71007031 Issued in IL
Practice address
28W671 Garys Mill Rd
Winfield, IL 60190-1564
Phone
(630) 293-9860
Fax
(630) 293-9861
NPI assigned
Mar 11, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 10, 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 71007031 IL Primary

Addresses

Primary practice location

28W671 Garys Mill Rd
Winfield, IL 60190-1564

Mailing address

28W671 Garys Mill Rd
Winfield, IL 60190-1564
Phone (630) 293-9860

Other practice location 1

3933 75th St
Aurora, IL 60504-8014
Phone (630) 293-9860

Other identifiers 1

IdentifierTypeStateIssuer
208302046OtherILTAX ID

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
I20110502000216 IL Practitioner - Clinical Psychologist 1153504907 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pathways Psychology Services PCGroup PAC ID 5294918017, 12 clinicians

Practice addresses (Care Compare)

28 W671 Garys Mill Rd
Winfield, IL 60190-1564
Phone (630) 293-9860

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
71007031ILMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Pathways Psychology Services P.C. Clinical CurrentSince Nov 6, 2010 Accepting new patients

Locations

3933 75th St
Ste 102
Aurora, IL 60504
Phone (630) 293-9860

28W671 Garys Mill Rd
Winfield, IL 60190
Phone (630) 293-9860

27W130 Roosevelt Rd
Ste 203
Winfield, IL 60190
Phone (630) 588-8490

Organizations & group practices 1

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": "1173571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644451200000",
    "number": "1144352626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28W671 GARYS MILL RD",
            "city": "WINFIELD",
            "state": "IL",
            "postal_code": "601901564",
            "telephone_number": "630-293-9860",
            "fax_number": "630-293-9861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28W671 GARYS MILL RD",
            "city": "WINFIELD",
            "state": "IL",
            "postal_code": "601901564",
            "telephone_number": "630-293-9860",
            "fax_number": "630-293-9861"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3933 75th St",
            "address_purpose": "LOCATION",
            "city": "Aurora",
            "state": "IL",
            "postal_code": "605048014",
            "country_code": "US",
            "telephone_number": "630-293-9860",
            "fax_number": "630-293-9861",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROSZKOWSKI",
        "first_name": "JOSEPH",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-11",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "71007031",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "208302046",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winfield, IL

Sources for this page

Verify at the official NPI Registry.