Kristina Maria Bouros, PSYD
Individual provider Active NPI Psychologist · Romeoville, IL
NPI 1164909156 · NPPES record last updated May 19, 2023
Key facts
- NPI
- 1164909156
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 071-010119 (IL)
- Practice address
- 1239 Windham Pkwy
Romeoville, IL 60446-1608 - Phone
- (815) 942-6323
- Fax
- (779) 210-5541
- NPI assigned
- Jul 23, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Dupage Medical Group LTD
Practice addresses (Care Compare)
30 Stratford Dr
Bloomingdale, IL 60108-2201
Phone (630) 893-2210
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20191213001833 | IL | Practitioner - Clinical Psychologist | 0840623393 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071-010119 | IL | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dupage Medical Group LTD | Current |
Accepting new patients | |
| Dupage Medical Group LTD | Current |
Accepting new patients |
Locations
30 Stratford Dr
Bloomingdale, IL 60108
Phone (630) 893-2210
1860 Paysphere Cir
Chicago, IL 60674
Phone (630) 469-2000
1401 Lakewood Dr
Ste A
Morris, IL 60450
1239 Windham Pkwy
Romeoville, IL 60446
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 071-010119 | IL | Yes |
Addresses
Primary practice location
1239 Windham Pkwy
Romeoville, IL 60446-1608
Mailing address
PO Box 713260
Chicago, IL 60677-0264
Phone (630) 469-9200
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | kbouros204772@dulyhealthandcare.direct-ci.com | Direct |
Other providers in Romeoville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 19, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.