Individual provider Active NPI

John M McConnell, PHD

  • Clinical Psychologist
  • Wheaton, IL
National Provider Identifier
1174884514
Registry record updated Mar 31, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071.009392 Issued in IL
Practice address
501 College Ave
Wheaton, IL 60187-5501
Phone
(630) 752-5762
NPI assigned
Jun 1, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 20042890A IN
Clinical Psychologist 103TC0700X 071.009392 IL Primary

Addresses

Primary practice location

501 College Ave
Wheaton, IL 60187-5501

Mailing address

120 E Ogden Ave
Ste 220
Hinsdale, IL 60521-3546
Phone (630) 325-5300

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
I20170810000175 IL Practitioner - Clinical Psychologist 6709161854 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Heritage Professional Associates LTDGroup PAC ID 6002707262, 18 clinicians

Practice addresses (Care Compare)

120 E Ogden Ave
Suite 220
Hinsdale, IL 60521-3546
Phone (630) 325-5300

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
071.009392ILMDClinical Psychologist
20042890AINMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Heritage Professional Associates LTD CurrentSince Jun 24, 2017 Accepting new patients

Locations

120 E Ogden Ave
Ste 220
Hinsdale, IL 60521
Phone (630) 325-5300

120 E Ogden Ave
Ste 2
Hinsdale, IL 60521
Phone (630) 325-5300

1737 S Naperville Rd
Ste 206
Wheaton, IL 60189
Phone (630) 325-5300

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": "1338508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490918400000",
    "number": "1174884514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 E OGDEN AVE",
            "address_2": "STE 220",
            "city": "HINSDALE",
            "state": "IL",
            "postal_code": "605213546",
            "telephone_number": "630-325-5300",
            "fax_number": "630-325-5309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 COLLEGE AVE",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601875501",
            "telephone_number": "630-752-5762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCONNELL",
        "first_name": "JOHN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-01",
        "last_updated": "2017-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20042890A",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.009392",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wheaton, IL

Sources for this page

Verify at the official NPI Registry.