Heather O'Brien, PSYD, HSPP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

20042680A Issued in IN

Practice address

808 S Eldorado Rd
Suite 102
Bloomington, IL 61704-6071

Phone

(309) 706-3190

Fax

(309) 588-4115

NPI assigned

Apr 9, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

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 and National Provider Directory roles.

• Edgewood Clinical Services, P.C.

  • Psychologist
  • Naperville, IL
  • NPI 1295914646
  Medicare reassignment NPD

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

{
    "created_epoch": "1365465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417651200000",
    "number": "1184067191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 WINDSOR RD",
            "address_2": "SUITE 2617",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618226217",
            "telephone_number": "217-693-6072",
            "fax_number": "309-588-4115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 S ELDORADO RD",
            "address_2": "SUITE 102",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617046071",
            "telephone_number": "309-706-3190",
            "fax_number": "309-588-4115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'BRIEN",
        "first_name": "HEATHER",
        "credential": "PSYD, HSPP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-04-09",
        "last_updated": "2014-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IN",
            "license": "20042680A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph A Novotny, M.D.
• Willard Noyes, M.D.
• Sena Ntumy
• Natasha K Nunoo Ponder
• Amy O'Brien, FNP
• Patricia O'Meara, MPT, NDT
• Barbara Amm O'Neal, M.S. LCPC
• Jerome W Oakey, M.D.
• Angela Oberreiter, O.D.
• Pascaline O Obika

• Psychologist in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2014; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.