Individual provider Active NPI

Paula Ruth Cormalleth, PSY D

  • Clinical Psychologist
  • Chicago, IL
National Provider Identifier
1144376229
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Practice address
75 E Wacker Drive
Suite 600
Chicago, IL 60601
Phone
(312) 553-9010
NPI assigned
Jan 25, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 IL Primary

Addresses

Primary practice location

75 E Wacker Drive
Suite 600
Chicago, IL 60601

Mailing address

75 E Wacker Drive
Suite 600
Chicago, IL 60601
Phone (312) 553-9010

Other identifiers 1

IdentifierTypeStateIssuer
0001673076OtherBLUE CROSS BLUE SHIELD

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
I20041012000738 IL Practitioner - Clinical Psychologist 0042270340 Practice locations: Lincolnwood, IL

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

6705 N Kedvale Ave
Lincolnwood, IL 60712-3511
Phone (847) 863-7697

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
071-003387ILMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Paula Cormalleth, LLC Clinical Current Accepting new patients

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": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1144376229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 E WACKER DRIVE",
            "address_2": "SUITE 600",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60601",
            "telephone_number": "312-553-9010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 E WACKER DRIVE",
            "address_2": "SUITE 600",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60601",
            "telephone_number": "312-553-9010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORMALLETH",
        "first_name": "PAULA",
        "middle_name": "RUTH",
        "name_prefix": "Mrs.",
        "credential": "PSY D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0001673076",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.