Individual provider Active NPI

Scott Mitchell, PSY.D

  • Clinical Psychologist
  • Naperville, IL
National Provider Identifier
1215024757
Registry record updated Oct 26, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Practice address
1819 Bay Scott Cir Ste 109
Naperville, IL 60540-1130
Phone
(630) 357-2456
Fax
(630) 357-2482
NPI assigned
Oct 6, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 26, 2007

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 IL Primary

Addresses

Primary practice location

1819 Bay Scott Cir Ste 109
Naperville, IL 60540-1130

Mailing address

1819 Bay Scott Cir Ste 109
Naperville, IL 60540-1130
Phone (630) 357-2456

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
I20160815001870 IL Practitioner - Clinical Psychologist 1153387626 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Samaritan Interfaith Counseling Center IncGroup PAC ID 8426014994, 19 clinicians

Practice addresses (Care Compare)

1819 Bay Scott Cir
Suite 109
Naperville, IL 60540-1129

1819 Bay Scott Cir
Suite 109
Naperville, IL 60540-1130
Phone (630) 357-2456

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
071-004701ILMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Samaritan Counseling Center PastSince Jul 25, 2016 Accepting new patients

Organizations & group practices 2

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": "1160092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193356800000",
    "number": "1215024757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1819 BAY SCOTT CIR STE 109",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605401130",
            "telephone_number": "630-357-2456",
            "fax_number": "630-357-2482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1819 BAY SCOTT CIR STE 109",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605401130",
            "telephone_number": "630-357-2456",
            "fax_number": "630-357-2482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "PSY.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-06",
        "last_updated": "2007-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Naperville, IL

Sources for this page

Verify at the official NPI Registry.