Charles Michael Ideran, D.MIN., LCPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LCPC 180-001087 Issued in IL

Practice address

6006 W. 159TH St
BLDG. C
Oak Forest, IL 60452

Phone

(708) 535-7320

NPI assigned

Jul 28, 2006

Last updated

Dec 4, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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

Mental Health Counselor

Education

Other, 1981

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Genesis Therapy CenterGroup PAC ID 9436461720, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Genesis Therapy Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Oak Forest, IL
  • NPI 1447264890
  Medicare reassignment Care Compare group NPD
• The Genesis Therapy Center

  • Community/Behavioral Health Agency
  • Oak Forest, IL
  • NPI 1891020137
  NPD

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733270400000",
    "number": "1265446652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1404 BRASSIE AVE",
            "city": "FLOSSMOOR",
            "state": "IL",
            "postal_code": "604221814",
            "telephone_number": "708-922-1194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6006 W. 159TH ST",
            "address_2": "BLDG. C",
            "city": "OAK FOREST",
            "state": "IL",
            "postal_code": "60452",
            "telephone_number": "708-535-7320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IDERAN",
        "first_name": "CHARLES",
        "middle_name": "MICHAEL",
        "credential": "D.MIN., LCPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2024-12-04",
        "certification_date": "2024-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "LCPC 180-001087",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180001087",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Toriano Humphrey II
• Gervaise Hunter-Morris, PHARMD
• Margaret Catherine Hurley, M.S., SLP-CF
• I Connect Interpreting Service Inc
• Sanah Ibrahim, RPH
• J. Sloane NFP (Sloane's Manor)
• Abraham Jacob, PT
• Rama D Jager, M.D.
• Farrukh Jahan, MD
• Felicia R James, PTA

• Mental Health Counselor in Oak Forest, IL
• Providers in Oak Forest, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2024; 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.