Individual provider Active NPI

Patricia L Roy, MD

  • Psychiatry Physician
  • Kankakee, IL
National Provider Identifier
1184636474
Registry record updated Nov 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
036088553 Issued in IL
Practice address
500 N Wall Street
Suite 200
Kankakee, IL 60901
Phone
(815) 937-1237
Fax
(815) 933-0662
NPI assigned
Aug 13, 2006
Last updated
Nov 20, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2024

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

Specialties & licenses 14

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X R0649 TX
Psychiatry Physician 2084P0800X 036088553 IL Primary
Psychiatry Physician 2084P0800X 303242 LA
Psychiatry Physician 2084P0800X 11019 SD
Psychiatry Physician 2084P0800X 61190 MN
Psychiatry Physician 2084P0800X 32127 OK
Psychiatry Physician 2084P0800X 04-39633 KS
Psychiatry Physician 2084P0800X 14465 ND
Psychiatry Physician 2084P0800X MD.35170 AL
Psychiatry Physician 2084P0800X 036-088553 IL
Psychiatry Physician 2084P0800X MD-43434 IA
Psychiatry Physician 2084P0800X 29254 NE
Psychiatry Physician 2084P0800X 66676 WI
Child & Adolescent Psychiatry Physician 2084P0804X 036088553 IL

Addresses

Primary practice location

500 N Wall Street
Suite 200
Kankakee, IL 60901

Mailing address

500 N Wall St
Suite 200
Kankakee, IL 60901-2942
Phone (815) 937-1237

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: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070914000556 IL Practitioner - Psychiatry 4385738830 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD.35170ALMDPsychiatry Physician
MD-43434IAMDPsychiatry Physician
036-088553ILMDPsychiatry Physician
04-39633KSMDPsychiatry Physician
303242LAMDPsychiatry Physician
61190MNMDPsychiatry Physician
14465NDMDPsychiatry Physician
29254NEMDPsychiatry Physician
32127OKMDPsychiatry Physician
11019SDMDPsychiatry Physician
R0649TXMDPsychiatry Physician
66676WIMDPsychiatry Physician
036088553ILMDChild & Adolescent Psychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carle Health Medical Group CurrentSince Jan 17, 2022 Accepting new patients
Edgewood Clinical Services, P.C. CurrentSince Dec 1, 2024 Accepting new patients
BHC Streamwood Hospital Inc. CurrentSince May 30, 2016 Accepting new patients
Psychology Specialists LTD Past Accepting new patients

Locations

808 S Eldorado Rd
Ste 102
Bloomington, IL 61704
Phone (309) 212-6007

581 Elm Pl
Ste 110
Highland Park, IL 60035
Phone (847) 861-7771

2948 Artesian Rd
Ste 112
Naperville, IL 60564
Phone (630) 328-0165

1400 E Irving Park Rd
Streamwood, IL 60107
Phone (630) 483-5578

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

175 E Hawthorne Pkwy
Ste 235
Vernon Hills, IL 60061
Phone (847) 865-4125

Interoperability endpoints

  • Direct secure messaging: lifestancehealth.patriciaroy@146897.advancedmd-direct.com
  • Direct secure messaging: proymd343909@carlehiedirect.net

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732060800000",
    "number": "1184636474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 N WALL ST",
            "address_2": "SUITE 200",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609012942",
            "telephone_number": "815-937-1237",
            "fax_number": "815-933-0662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 N WALL STREET",
            "address_2": "SUITE 200",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "60901",
            "telephone_number": "815-937-1237",
            "fax_number": "815-933-0662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROY",
        "first_name": "PATRICIA",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-13",
        "last_updated": "2024-11-20",
        "certification_date": "2024-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "R0649",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036088553",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "LA",
            "license": "303242",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "SD",
            "license": "11019",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MN",
            "license": "61190",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OK",
            "license": "32127",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "KS",
            "license": "04-39633",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "ND",
            "license": "14465",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "AL",
            "license": "MD.35170",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036-088553",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IA",
            "license": "MD-43434",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NE",
            "license": "29254",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WI",
            "license": "66676",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "IL",
            "license": "036088553",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kankakee, IL

Sources for this page

Verify at the official NPI Registry.