Individual provider Active NPI

Lisa Marie Petrongelli, PSY.D, APRN-BC, FPA

  • Psychiatric/Mental Health Nurse Practitioner
  • Hoffman Estates, IL
National Provider Identifier
1306281332
Registry record updated Mar 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
277000902 Issued in IL
Practice address
1776 Moon Lake Blvd
Hoffman Estates, IL 60169-1010
Phone
(847) 882-4181
Fax
(847) 882-4299
NPI assigned
May 3, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 26, 2026

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

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 277000902 IL Primary
Addiction (Substance Use Disorder) Psychologist 103TA0400X
Women's Health Nurse Practitioner 363LW0102X 277000902 IL
Health Service Psychologist 103TH0100X
Family Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LF0000X 277000902 IL
Psychologist 103T00000X
Clinical Child & Adolescent Psychologist 103TC2200X
Nurse Practitioner 363L00000X 209004881 IL
Group Psychotherapy Psychologist 103TP2701X
Adult Health Nurse Practitioner 363LA2200X 277000902 IL

Addresses

Primary practice location

1776 Moon Lake Blvd
Hoffman Estates, IL 60169-1010

Mailing address

1776 Moon Lake Blvd
Hoffman Estates, IL 60169-1010
Phone (847) 228-4181

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: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031219000456 IL Practitioner - Nurse Practitioner 1153229885 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
277000902ILMDWomen's Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fred J. Halloran, MD, SC Single Specialty CurrentSince Jul 1, 2013 Accepting new patients

Locations

1015 S Evergreen Ave
Arlington Hts, IL 60005
Phone (770) 570-0021

11904 Oak Creek Pkwy
Huntley, IL 60142
Phone (770) 570-0021

Organizations & group practices 1

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": "1367539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774483200000",
    "number": "1306281332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1776 MOON LAKE BLVD",
            "city": "HOFFMAN ESTATES",
            "state": "IL",
            "postal_code": "601691010",
            "telephone_number": "847-228-4181",
            "fax_number": "847-882-4299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1776 MOON LAKE BLVD",
            "city": "HOFFMAN ESTATES",
            "state": "IL",
            "postal_code": "601691010",
            "telephone_number": "847-882-4181",
            "fax_number": "847-882-4299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRONGELLI",
        "first_name": "LISA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "PSY.D, APRN-BC, FPA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-05-03",
        "last_updated": "2026-03-26",
        "certification_date": "2026-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "277000902",
            "primary": true
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "IL",
            "license": "277000902",
            "primary": false
        },
        {
            "code": "103TH0100X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health Service",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "277000902",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209004881",
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IL",
            "license": "277000902",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hoffman Estates, IL

Sources for this page

Verify at the official NPI Registry.