Family Care Associates of Bourbonnais, Inc.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071.009770 Issued in IL

Legal business name

FAMILY CARE ASSOCIATES OF BOURBONNAIS, INC.

Practice address

750 Almar Pkwy Ste 204
Bourbonnais, IL 60914-2399

Phone

(815) 214-9872

NPI assigned

Jun 18, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Benjamin Kunz, PSY.D.NPI 1801165147

Title

President

Phone

(815) 214-9872

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Benjamin Kunz, PSY.D.

  • Clinical Psychologist
  • Dubuque, IA
  • NPI 1801165147

  IL

  Medicare reassignment Authorized official
• Karie Renae Alderson, LCSW

  • Clinical Social Worker
  • Bourbonnais, IL
  • NPI 1770273393
  NPD
• Lisa Vander Veer, PSYD

  • Clinical Psychologist
  • Bourbonnais, IL
  • NPI 1750947370

  Clinical

  NPD (past)

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

{
    "created_epoch": "1529280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529280000000",
    "number": "1396239802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 ALMAR PKWY STE 204",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609142399",
            "telephone_number": "815-214-9872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 ALMAR PKWY STE 204",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609142399",
            "telephone_number": "815-214-9872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY CARE ASSOCIATES OF BOURBONNAIS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-18",
        "last_updated": "2018-06-18",
        "status": "A",
        "authorized_official_last_name": "KUNZ",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-214-9872",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.009770",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica D Evans, PTA
• Taylor Ewing, MA, NCC, LCPC
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• Katelin Fane, PT
• Gail Ferrebee, PT
• Jason William Ferris, PT
• Susan Jean Ferris, LCPC
• Zachary Steven Fienhold

• All providers in Bourbonnais, IL
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2018; 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.