Individual provider Active NPI

Kenneth Robert Lofland, PHD

  • Psychologist
  • Chicago, IL
National Provider Identifier
1255406567
Registry record updated Nov 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
071005140 Issued in IL
Practice address
233 E Erie St
#204
Chicago, IL 60611-2926
Phone
(847) 920-4644
NPI assigned
Nov 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 071005140 IL Primary

Addresses

Primary practice location

233 E Erie St
#204
Chicago, IL 60611-2926

Mailing address

PO Box 1592
Deerfield, IL 60015-6009
Phone (847) 920-4644

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
I20050322001106 IL Practitioner - Clinical Psychologist 6406802552 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

5 Revere Dr
Suite 200
Northbrook, IL 60062-8000
Phone (847) 920-4644

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
071005140ILMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Northshore Integrative Healthcare CurrentSince Jun 15, 2011 Accepting new patients
The Pain & Rehabilitation Clinic of Chicago Psychologist Past Accepting new patients
M.H.R.C. Inc. Past Accepting new patients

Locations

500 Lake Cook Rd
Ste 350
Deerfield, IL 60015
Phone (847) 363-5845

1800 Hollister Dr
Ste 206
Libertyville, IL 60048
Phone (847) 549-1609

185 Milwaukee Ave
Ste 230
Lincolnshire, IL 60069
Phone (847) 883-0077

5 Revere Dr
Ste 200
Northbrook, IL 60062
Phone (630) 291-3206

455 S Roselle Rd
Ste 104
Schaumburg, IL 60193
Phone (847) 352-5511

Organizations & group practices 3

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": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414972800000",
    "number": "1255406567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1592",
            "city": "DEERFIELD",
            "state": "IL",
            "postal_code": "600156009",
            "telephone_number": "847-920-4644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "233 E ERIE ST",
            "address_2": "#204",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112926",
            "telephone_number": "847-920-4644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOFLAND",
        "first_name": "KENNETH",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-21",
        "last_updated": "2014-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IL",
            "license": "071005140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.