NPIMap

Organization Active NPI

Jeffery C. Teich M.D. S.C.

  • Psychiatry Physician
  • Evanston, IL
National Provider Identifier
1265604748
Registry record updated Jun 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
JEFFERY C. TEICH M.D. S.C.
Practice address
636 Church St
Suite #407
Evanston, IL 60201-4508
Phone
(847) 869-3702
Fax
(847) 869-8945
NPI assigned
Mar 25, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2012

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

Authorized official

Name
Dr. Jeffrey C Teich, M.D.NPI 1467467910
Title
Owner
Phone
(847) 869-3702

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

636 Church St
Suite #407
Evanston, IL 60201-4508

Mailing address

636 Church St
Suite #407
Evanston, IL 60201-4508
Phone (847) 869-3702

Other identifiers 2

IdentifierTypeStateIssuer
036045916MedicaidIL
1622238OtherILBLUE CROSS BLUE SHIELD IL

National Provider Directory

National Provider Directory

Locations

636 Church St
Ste 407
Evanston, IL 60201
Phone (847) 370-5096

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1206403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340064000000",
    "number": "1265604748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "636 CHURCH ST",
            "address_2": "SUITE #407",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602014508",
            "telephone_number": "847-869-3702",
            "fax_number": "847-869-8945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "636 CHURCH ST",
            "address_2": "SUITE #407",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602014508",
            "telephone_number": "847-869-3702",
            "fax_number": "847-869-8945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERY C. TEICH M.D. S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-25",
        "last_updated": "2012-06-19",
        "status": "A",
        "authorized_official_last_name": "TEICH",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-869-3702",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036045916",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD IL",
            "identifier": "1622238",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Evanston, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.