Individual provider Active NPI

Robert Kevin Heinrich, PH.D.

  • Clinical Psychologist
  • Lake Forest, IL
National Provider Identifier
1285641092
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Practice address
900 N Westmoreland Rd
Suite 216
Lake Forest, IL 60045-1674
Phone
(847) 615-9900
NPI assigned
Aug 2, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X IL Primary

Addresses

Primary practice location

900 N Westmoreland Rd
Suite 216
Lake Forest, IL 60045-1674

Mailing address

900 N Westmoreland Rd
Suite 216
Lake Forest, IL 60045-1674
Phone (847) 615-9900

Other identifiers 1

IdentifierTypeStateIssuer
04927734OtherILBLUE CROSS / BLUE SHIELD

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
I20100821000001 IL Practitioner - Clinical Psychologist 3375539166 Practice locations: Lake Bluff, IL

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

655 Rockland Rd
Lake Bluff, IL 60044-1779
Phone (847) 615-9900

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
071006220ILMDClinical Psychologist

NPI Registry JSON

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1285641092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 N WESTMORELAND RD",
            "address_2": "SUITE 216",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600451674",
            "telephone_number": "847-615-9900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 N WESTMORELAND RD",
            "address_2": "SUITE 216",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600451674",
            "telephone_number": "847-615-9900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEINRICH",
        "first_name": "ROBERT",
        "middle_name": "KEVIN",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS / BLUE SHIELD",
            "identifier": "04927734",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Forest, IL

Sources for this page

Verify at the official NPI Registry.