Individual provider Active NPI

Judith Trigg, PSY.D

  • Clinical Psychologist
  • Rockford, IL
National Provider Identifier
1245243237
Registry record updated Apr 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071004991 Issued in IL
Practice address
6072 Brynwood Dr
Ste 105
Rockford, IL 61114-5829
Phone
(815) 398-7000
Fax
(815) 395-0671
NPI assigned
Aug 14, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 28, 2017

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 071004991 IL Primary

Addresses

Primary practice location

6072 Brynwood Dr
Ste 105
Rockford, IL 61114-5829

Mailing address

6975 Redansa Dr
Rockford, IL 61108-1201
Phone (815) 398-7000

Other identifiers 1

IdentifierTypeStateIssuer
10132003OtherILBCBS

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
I20120419000163 IL Practitioner - Clinical Psychologist 6800057803 Practice locations: Rockford, IL

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

6072 Brynwood Dr
Suite 105
Rockford, IL 61114-5829
Phone (815) 847-6666

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493337600000",
    "number": "1245243237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6975 REDANSA DR",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611081201",
            "telephone_number": "815-398-7000",
            "fax_number": "815-395-0671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6072 BRYNWOOD DR",
            "address_2": "STE 105",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611145829",
            "telephone_number": "815-398-7000",
            "fax_number": "815-395-0671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRIGG",
        "first_name": "JUDITH",
        "credential": "PSY.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-14",
        "last_updated": "2017-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071004991",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "10132003",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

Verify at the official NPI Registry.