Kelly Bauman, PSY.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071008887 Issued in IL

Practice address

457 Coventry LN Ste 115
Crystal Lake, IL 60014-7571

Phone

(815) 245-4825

Fax

(815) 596-1008

NPI assigned

Aug 12, 2011

Last updated

May 21, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

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

Specialty

Clinical Psychologist

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bauman Psychotherapy Collaborations, LLC

  • Adult Mental Health Clinic/Center
  • Crystal Lake, IL
  • NPI 1235701905
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1313107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621555200000",
    "number": "1174802730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 S EASTWOOD DR STE 166",
            "city": "WOODSTOCK",
            "state": "IL",
            "postal_code": "600984635",
            "telephone_number": "815-245-4825",
            "fax_number": "815-596-1008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "457 COVENTRY LN STE 115",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600147571",
            "telephone_number": "815-245-4825",
            "fax_number": "815-596-1008"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3703 Doty Rd",
            "address_purpose": "LOCATION",
            "city": "Woodstock",
            "state": "IL",
            "postal_code": "600987517",
            "country_code": "US",
            "telephone_number": "800-765-9999",
            "fax_number": "815-206-2822",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "360 Station Dr Ste 100",
            "address_purpose": "LOCATION",
            "city": "Crystal Lake",
            "state": "IL",
            "postal_code": "60014",
            "country_code": "US",
            "telephone_number": "815-338-6600",
            "fax_number": "815-356-2324",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "360 Station Dr Ste 100",
            "address_purpose": "LOCATION",
            "city": "Crystal Lake",
            "state": "IL",
            "postal_code": "60014",
            "country_code": "US",
            "telephone_number": "815-338-6600",
            "fax_number": "815-356-2324",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BAUMAN",
        "first_name": "KELLY",
        "credential": "PSY.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-08-12",
        "last_updated": "2021-05-21",
        "certification_date": "2021-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071008887",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "IL",
            "license": "166.000207",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "166.000207",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "071008887",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert Henry Basile, DMD
• Heather Marie Bassett, LSW
• Michelle A Bate, NP
• Luann Bauer
• Bauman Psychotherapy Collaborations, LLC
• Mikayla Bavaro, LSW
• Honeid Mohsin Baxamusa, M.D.
• Rahil Baxamusa, DPM
• Richard Joseph Bayram III
• BDD Alcd PC (Advanced Laser & Cosmetic Dentistry)

• Clinical Psychologist in Crystal Lake, IL
• Providers in Crystal Lake, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.