Individual provider Active NPI

Patrick David Martin, LPC

  • Professional Counselor
  • Westmont, IL
National Provider Identifier
1396458451
Registry record updated Jan 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
178.018721 Issued in IL
Practice address
414 Plaza Dr Ste 301
Westmont, IL 60559-5508
Phone
(630) 728-1744
NPI assigned
Jan 3, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 178.018721 IL Primary

Addresses

Primary practice location

414 Plaza Dr Ste 301
Westmont, IL 60559-5508

Mailing address

414 Plaza Dr Ste 301
Westmont, IL 60559-5508

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240206001481 IL Practitioner - Mental Health Counselor 1951744051 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
178.018721ILMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Grace Integrated, LLC Professional CurrentSince Jan 1, 2024 Accepting new patients

Locations

2500 S Highland Ave
Ste 325
Lombard, IL 60148
Phone (630) 495-9810

125 Windsor Dr
Ste 113
Oak Brook, IL 60523
Phone (630) 728-1744

414 Plaza Dr
Ste 301
Westmont, IL 60559
Phone (630) 728-1744

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": "1672704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672704000000",
    "number": "1396458451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "414 PLAZA DR STE 301",
            "city": "WESTMONT",
            "state": "IL",
            "postal_code": "605595508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "414 PLAZA DR STE 301",
            "city": "WESTMONT",
            "state": "IL",
            "postal_code": "605595508",
            "telephone_number": "630-728-1744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "PATRICK",
        "middle_name": "DAVID",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-01-03",
        "last_updated": "2023-01-03",
        "certification_date": "2023-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "178.018721",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Westmont, IL

Sources for this page

Verify at the official NPI Registry.