Active NPI
Jan L. Fitzhugh, PSYD
- Clinical Psychologist
- Park Ridge, IL
National Provider Identifier
1255397634
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071-00648
- Practice address
- 2604 Dempster St
Suite 307
Park Ridge, IL 60068-8412 - Phone
- (847) 544-5102
- Fax
- (847) 544-5103
- NPI assigned
- Apr 25, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 | 071-00648 | IL | Primary |
Addresses
Primary practice location
2604 Dempster St
Suite 307
Park Ridge, IL 60068-8412
Mailing address
756 Lincoln Ave
Winnetka, IL 60093-1919
Phone (847) 530-2444
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01632426 | Other | IL | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071-00648 | IL | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pro Psych Associates SC | Clinical | Past | Accepting new patients |
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1255397634",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "756 LINCOLN AVE",
"city": "WINNETKA",
"state": "IL",
"postal_code": "600931919",
"telephone_number": "847-530-2444",
"fax_number": "847-441-0551"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2604 DEMPSTER ST",
"address_2": "SUITE 307",
"city": "PARK RIDGE",
"state": "IL",
"postal_code": "600688412",
"telephone_number": "847-544-5102",
"fax_number": "847-544-5103"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FITZHUGH",
"first_name": "JAN",
"middle_name": "L.",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-04-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071-00648",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "01632426",
"state": "IL"
}
],
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.