NPIMap

Organization Active NPI

Psychological Services of Central Illinois, P.C.

  • Clinical Psychologist
  • Springfield, IL
National Provider Identifier
1245281583
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
PSYCHOLOGICAL SERVICES OF CENTRAL ILLINOIS, P.C.
Practice address
2921 Greenbriar Dr
Suite B-1
Springfield, IL 62704-6425
Phone
(217) 546-3118
Fax
(217) 546-3184
NPI assigned
May 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Dr. Richard E. Dimond, PH.D.
Title
President
Phone
(217) 546-3118

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X IL Primary

Addresses

Primary practice location

2921 Greenbriar Dr
Suite B-1
Springfield, IL 62704-6425

Mailing address

2921 Greenbriar Dr
Suite B-1
Springfield, IL 62704-6425
Phone (217) 546-3118

Other identifiers 2

IdentifierTypeStateIssuer
0008423762OtherILHMO ILLINOIS
0008423762OtherILBLUE CROSS-BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061030000127 IL Part B Supplier - Clinic/Group Practice 5193722452 Receives reassigned benefits from 8 practitioners
Practice locations: Springfield, IL

National Provider Directory

National Provider Directory

Locations

2921 Greenbriar Dr
Ste B1
Springfield, IL 62704
Phone (217) 546-3118

2815 Old Jacksonville Rd
Ste 202
Springfield, IL 62704
Phone (217) 525-6200

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1245281583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2921 GREENBRIAR DR",
            "address_2": "SUITE B-1",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627046425",
            "telephone_number": "217-546-3118",
            "fax_number": "217-546-3184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2921 GREENBRIAR DR",
            "address_2": "SUITE B-1",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627046425",
            "telephone_number": "217-546-3118",
            "fax_number": "217-546-3184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHOLOGICAL SERVICES OF CENTRAL ILLINOIS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-12",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "DIMOND",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "217-546-3118",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMO ILLINOIS",
            "identifier": "0008423762",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS-BLUE SHIELD",
            "identifier": "0008423762",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.