Active NPI
Robert Bruce Campbell, PSY.D., M.DIV.
- Clinical Psychologist
- Park Ridge, IL
National Provider Identifier
1225375389
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071008486
- Practice address
- 1400 Renaissance Dr
Suite 401
Park Ridge, IL 60068-1329 - Phone
- (847) 318-8200
- Fax
- (847) 318-9170
- NPI assigned
- Jan 9, 2013
- Last updated
- Jan 9, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 071008486 | IL | Primary |
Addresses
Primary practice location
1400 Renaissance Dr
Suite 401
Park Ridge, IL 60068-1329
Mailing address
1400 Renaissance Dr
Suite 401
Park Ridge, IL 60068-1329
Phone (847) 318-8200
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2604 Dempster St
Suite 402
Park Ridge, IL 60068-8438
Phone (847) 318-8200
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071008486 | IL | MD | Clinical Psychologist |
Organizations & group practices 1
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.
-
- Adult Mental Health Clinic/Center
- Park Ridge, IL
- NPI 1154437739
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1357689600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1357689600000",
"number": "1225375389",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1400 RENAISSANCE DR",
"address_2": "SUITE 401",
"city": "PARK RIDGE",
"state": "IL",
"postal_code": "600681329",
"telephone_number": "847-318-8200",
"fax_number": "847-318-9170"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 RENAISSANCE DR",
"address_2": "SUITE 401",
"city": "PARK RIDGE",
"state": "IL",
"postal_code": "600681329",
"telephone_number": "847-318-8200",
"fax_number": "847-318-9170"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAMPBELL",
"first_name": "ROBERT",
"middle_name": "BRUCE",
"name_prefix": "Dr.",
"credential": "PSY.D., M.DIV.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-01-09",
"last_updated": "2013-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071008486",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Park Ridge, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2013; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.