Individual provider Active NPI

Kristin Rene Krueger, PHD

  • Clinical Neuropsychologist
  • Elmhurst, IL
National Provider Identifier
1174716682
Registry record updated Dec 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
071.007107 Issued in IL
Practice address
110 E Schiller St Ste 306
306
Elmhurst, IL 60126-2823
Phone
(312) 883-2358
NPI assigned
Aug 20, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 6, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X 071.007107 IL Primary

Addresses

Primary practice location

110 E Schiller St Ste 306
306
Elmhurst, IL 60126-2823

Mailing address

110 E Schiller St Ste 306
306
Elmhurst, IL 60126-2823
Phone (312) 883-2358

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
I20111229000097 IL Practitioner - Clinical Psychologist 1951577782 Reassigns benefits to 1 organization
Receives reassigned benefits from 1 practitioner
Practice locations: Elmhurst, IL

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cook CountyGroup PAC ID 2860398088, 770 clinicians

Practice addresses (Care Compare)

500 E 51St St
Chicago, IL 60615-2494
Phone (312) 572-2000

Hospital & facility affiliations

  • Provident Hospital of Chicago Hospital, Chicago, IL, CCN 140300

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
071.007107ILMDClinical Neuropsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Cook County CurrentSince Nov 20, 2011 Accepting new patients
Cook County CurrentSince Nov 20, 2011 Accepting new patients
Kristin Krueger Clinical Neuropsychologist CurrentSince Dec 20, 2020 Accepting new patients
Cook County Current Accepting new patients

Locations

500 E 51st St
Chicago, IL 60615
Phone (312) 572-2000

1901 W Harrison St
Chicago, IL 60612
Phone (312) 864-5100

110 E Schiller St
Ste 306
Elmhurst, IL 60126
Phone (312) 883-2358

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Organizations & group practices 4

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 5

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": "1187568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480982400000",
    "number": "1174716682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 E SCHILLER ST STE 306",
            "address_2": "306",
            "city": "ELMHURST",
            "state": "IL",
            "postal_code": "601262823",
            "telephone_number": "312-883-2358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 E SCHILLER ST STE 306",
            "address_2": "306",
            "city": "ELMHURST",
            "state": "IL",
            "postal_code": "601262823",
            "telephone_number": "312-883-2358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRUEGER",
        "first_name": "KRISTIN",
        "middle_name": "RENE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-08-20",
        "last_updated": "2016-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "IL",
            "license": "071.007107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elmhurst, IL

Sources for this page

Verify at the official NPI Registry.