NPIMap

Organization Active NPI

Vibrant Integrative Psychiatry PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Gurnee, IL
National Provider Identifier
1356050769
Registry record updated Apr 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
VIBRANT INTEGRATIVE PSYCHIATRY PLLC
Practice address
1761 N Dilleys Rd Ste 211
Gurnee, IL 60031-1710
Phone
(224) 285-6006
NPI assigned
Nov 15, 2022
Last updated
Apr 10, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2023

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

Authorized official

Name
Ilya Ray, APNPNPI 1447639737
Title
Owner/Apnp
Phone
(224) 285-6006

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
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

1761 N Dilleys Rd Ste 211
Gurnee, IL 60031-1710

Mailing address

1761 N Dilleys Rd Ste 211
Gurnee, IL 60031-1710
Phone (224) 285-6006

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230425001562 IL Part B Supplier - Clinic/Group Practice 7911362033 Receives reassigned benefits from 2 practitioners
Practice locations: Gurnee, IL

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Vibrant Integrative Psychiatry2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1761 N Dilleys Rd
Ste 211
Gurnee, IL 60031
Phone (224) 285-6006

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": "1668470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681084800000",
    "number": "1356050769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1761 N DILLEYS RD STE 211",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600311710",
            "telephone_number": "224-285-6006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1761 N DILLEYS RD STE 211",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600311710",
            "telephone_number": "224-285-6006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIBRANT INTEGRATIVE PSYCHIATRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-15",
        "last_updated": "2023-04-10",
        "certification_date": "2023-04-10",
        "status": "A",
        "authorized_official_last_name": "RAY",
        "authorized_official_first_name": "ILYA",
        "authorized_official_title_or_position": "OWNER/APNP",
        "authorized_official_telephone_number": "224-285-6006",
        "authorized_official_credential": "APNP"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gurnee, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2023; 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.