Individual provider Active NPI

Mai Tue Nguyen, MD

  • Psychiatry Physician
  • Chicago, IL
National Provider Identifier
1225491954
Registry record updated Aug 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
036.149677 Issued in IL
Practice address
4753 N Broadway St Suite 910
Chicago, IL 60640-4991
Phone
(773) 989-2780
Fax
(773) 989-2781
NPI assigned
Mar 31, 2016
Last updated
Aug 6, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 036.149677 IL Primary

Addresses

Primary practice location

4753 N Broadway St Suite 910
Chicago, IL 60640-4991

Mailing address

4753 N Broadway St Suite 910
Chicago, IL 60640-4991
Phone (773) 989-2780

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
I20200929000190 IL Practitioner - Psychiatry 9032404637 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Baylor College of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

4753 N Broadway St
Suite 403
Chicago, IL 60640-7910
Phone (773) 989-2780

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.149677ILMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Behavioral Care of Colorado, P.C. CurrentSince Jul 21, 2024 Accepting new patients
Optum Behavioral Care of Colorado, P.C. CurrentSince Jul 21, 2024 Accepting new patients

Locations

4753 N Broadway St
Ste 403
Chicago, IL 60640
Phone (773) 989-2780

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, 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": "1459382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596672000000",
    "number": "1225491954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4753 N BROADWAY ST SUITE 910",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606404991",
            "telephone_number": "773-989-2780",
            "fax_number": "773-989-2781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4753 N BROADWAY ST SUITE 910",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606404991",
            "telephone_number": "773-989-2780",
            "fax_number": "773-989-2781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "MAI",
        "middle_name": "TUE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-31",
        "last_updated": "2020-08-06",
        "certification_date": "2020-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036.149677",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.