Individual provider Active NPI

Rakesh R Nair, PSYD

  • Clinical Psychologist
  • Chicago, IL
National Provider Identifier
1205595329
Registry record updated Dec 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071010647 Issued in IL
Practice address
1100 S Hamilton Ave
Chicago, IL 60612-4207
Phone
(312) 433-7102
NPI assigned
Dec 16, 2021
Last updated
Dec 16, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 071010647 IL Primary

Addresses

Primary practice location

1100 S Hamilton Ave
Chicago, IL 60612-4207

Mailing address

645 Burdette Ave
Glendale Heights, IL 60139-3365
Phone (630) 340-9635

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
I20220211001205 IL Practitioner - Clinical Psychologist 5991198111 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
071010647ILMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Cook County Current Accepting new patients
Cook County CurrentSince Jan 7, 2022 Accepting new patients
Cook County CurrentSince Jan 7, 2022 Accepting new patients

Locations

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

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

Organizations & group practices 3

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": "1639612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639612800000",
    "number": "1205595329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "645 BURDETTE AVE",
            "city": "GLENDALE HEIGHTS",
            "state": "IL",
            "postal_code": "601393365",
            "telephone_number": "630-340-9635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 S HAMILTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606124207",
            "telephone_number": "312-433-7102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NAIR",
        "first_name": "RAKESH",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-12-16",
        "last_updated": "2021-12-16",
        "certification_date": "2021-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071010647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.