Individual provider Active NPI

Lukasz Konopka

  • Psychologist
  • Romeoville, IL
National Provider Identifier
1215469911
Registry record updated May 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
071.009520 Issued in IL
Practice address
1239 Windham Pkwy
Romeoville, IL 60446-1608
Phone
(815) 942-6323
Fax
(779) 210-5541
NPI assigned
Mar 31, 2017
Last updated
May 24, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 24, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 071.009520 IL Primary

Addresses

Primary practice location

1239 Windham Pkwy
Romeoville, IL 60446-1608

Mailing address

PO Box 713260
Chicago, IL 60677-0264
Phone (630) 469-9200

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lkonopka204728@dulyhealthandcare.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, WI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20170926001116 IL Practitioner - Clinical Psychologist 6507130887 Reassigns benefits to 1 organization
I20241105001871 WI Practitioner - Clinical Psychologist 6507130887 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Primary Connection Health Care, Inc.Group PAC ID 3870577935, 9 clinicians

Practice addresses (Care Compare)

1810 N 2ND St
Wausau, WI 54403-3492
Phone (715) 848-4884

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
071.009520ILMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Primary Connection Health Care, Inc. CurrentSince Aug 30, 2024 Accepting new patients
Dupage Medical Group LTD CurrentSince Jan 1, 2022 Accepting new patients
Dupage Medical Group LTD CurrentSince Jan 1, 2022 Accepting new patients
Spectrum Center for Integrative Neuroscience PC Psychologist PastSince Nov 1, 2016 Accepting new patients

Locations

30 Stratford Dr
Bloomingdale, IL 60108
Phone (630) 893-2210

1860 Paysphere Cir
Chicago, IL 60674
Phone (630) 469-2000

1401 Lakewood Dr
Ste A
Morris, IL 60450

1239 Windham Pkwy
Romeoville, IL 60446

1810 N 2nd St
Wausau, WI 54403
Phone (715) 848-4884

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": "1490918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684886400000",
    "number": "1215469911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 713260",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606770264",
            "telephone_number": "630-469-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1239 WINDHAM PKWY",
            "city": "ROMEOVILLE",
            "state": "IL",
            "postal_code": "604461608",
            "telephone_number": "815-942-6323",
            "fax_number": "779-210-5541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KONOPKA",
        "first_name": "LUKASZ",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-31",
        "last_updated": "2023-05-24",
        "certification_date": "2023-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IL",
            "license": "071.009520",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lkonopka204728@dulyhealthandcare.direct-ci.com",
            "affiliation": "N",
            "address_1": "1239 Windham Pkwy",
            "city": "Romeoville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604461608",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Romeoville, IL

Sources for this page

Verify at the official NPI Registry.