Jennie McCormick, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

178013380 Issued in IL

Practice address

2200 Lake Victoria Dr
Springfield, IL 62703-5596

Phone

(217) 529-9266

NPI assigned

Oct 22, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Clinical Psychologist

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Mind and Body Wellness LLCGroup PAC ID 6002244118, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Mind and Body Wellness LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Tinley Park, IL
  • NPI 1598391229
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1540166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540166400000",
    "number": "1255807871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 E JACKSON BLVD STE 1500",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606044137",
            "telephone_number": "312-663-1130",
            "fax_number": "312-663-0504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 LAKE VICTORIA DR",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627035596",
            "telephone_number": "217-529-9266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCORMICK",
        "first_name": "JENNIE",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-22",
        "last_updated": "2018-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "178013380",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Megan Elizabeth McClure, LCPC
• Mary McCollum, OTD, OTR/L
• Lois N. McConomy, LCSW
• Carrie McCormick, APN
• Jarred Dean McCormick II
• Kara Lynn McCoy, M.D.
• Michelle Lee McCoy, CNOR,RNFA
• Savannah McCoy, RBT
• Matthew Tyler McCracken, MD
• Maureen McCue

• Professional Counselor in Springfield, IL
• Providers in Springfield, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.