NPIMap

Organization Active NPI

Main St. Psychiatry, S.C.

  • Psychiatry Physician
  • Cary, IL
National Provider Identifier
1346756491
Registry record updated Nov 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
36-086270 Issued in IL
Legal business name
MAIN ST. PSYCHIATRY, S.C.
Practice address
10 W Main St
Cary, IL 60013-2866
Phone
(815) 526-3781
Fax
(815) 526-3094
NPI assigned
Dec 26, 2017
Last updated
Nov 22, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2024

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

Authorized official

Name
Dr. Joanne Gail Parks, M.D.NPI 1619019148
Title
Owner/Medical Director
Phone
(815) 526-3781

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 36-086270 IL Primary

Addresses

Primary practice location

10 W Main St
Cary, IL 60013-2866

Mailing address

5911 Northwest Hwy Ste 207
Crystal Lake, IL 60014-8043
Phone (815) 526-3781

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180606000720 IL Part B Supplier - Clinic/Group Practice 0648535013 Receives reassigned benefits from 6 practitioners
Practice locations: Cary, IL

National Provider Directory

National Provider Directory

Locations

10 W Main St
Cary, IL 60013
Phone (773) 251-7392

10 W Main St
Ste 101
Cary, IL 60013
Phone (815) 526-3781

Practitioners & affiliated clinicians

Practitioners 6

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": "1514246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732233600000",
    "number": "1346756491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5911 NORTHWEST HWY STE 207",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600148043",
            "telephone_number": "815-526-3781",
            "fax_number": "815-526-3094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 W MAIN ST",
            "city": "CARY",
            "state": "IL",
            "postal_code": "600132866",
            "telephone_number": "815-526-3781",
            "fax_number": "815-526-3094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN ST. PSYCHIATRY, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-26",
        "last_updated": "2024-11-22",
        "certification_date": "2024-11-22",
        "status": "A",
        "authorized_official_last_name": "PARKS",
        "authorized_official_first_name": "JOANNE",
        "authorized_official_middle_name": "GAIL",
        "authorized_official_title_or_position": "OWNER/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "815-526-3781",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "36-086270",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cary, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.