Individual provider Active NPI

James R Hammond, PHD

  • Clinical Psychologist
  • Schaumburg, IL
National Provider Identifier
1376755397
Registry record updated Aug 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071-004681 Issued in IL
Practice address
1325 Wiley Rd
Suite 165
Schaumburg, IL 60173-4383
Phone
(630) 674-7881
Fax
(847) 310-4690
NPI assigned
May 3, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 21, 2019

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 071-004681 IL Primary

Addresses

Primary practice location

1325 Wiley Rd
Suite 165
Schaumburg, IL 60173-4383

Mailing address

3200 Sheridan Rd
Ste 104
Kenosha, WI 53140-1921
Phone (630) 674-7881

Other identifiers 1

IdentifierTypeStateIssuer
12007736OtherCAQH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20090408000647 WI Practitioner - Clinical Psychologist 5890860456 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1991
Medicare assignment
May accept Medicare assignment
Group practices
Thrive Therapy Services LLC 4 clinicians

Practice addresses (Care Compare)

3200 Sheridan Rd
Suite 104
Kenosha, WI 53140-1921
Phone (262) 997-9411

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
071-004681ILMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Thrive Therapy Services LLC CurrentSince Jun 11, 2019 Accepting new patients
Davken Associates, P.C. Clinical PastSince May 1, 2016 Accepting new patients

Locations

3200 Sheridan Rd
Ste 104
Kenosha, WI 53140
Phone (262) 288-6216

Organizations & group practices 2

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": "1178150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566345600000",
    "number": "1376755397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 SHERIDAN RD",
            "address_2": "STE 104",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531401921",
            "telephone_number": "630-674-7881",
            "fax_number": "847-310-4690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 WILEY RD",
            "address_2": "SUITE 165",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601734383",
            "telephone_number": "630-674-7881",
            "fax_number": "847-310-4690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAMMOND",
        "first_name": "JAMES",
        "middle_name": "R",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-03",
        "last_updated": "2019-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071-004681",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12007736",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Schaumburg, IL

Sources for this page

Verify at the official NPI Registry.