Organization Active NPI

Platinum Psychology Services Inc

  • Psychologist
  • Warrenville, IL
National Provider Identifier
1407477052
Registry record updated Feb 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
PLATINUM PSYCHOLOGY SERVICES INC
Practice address
4320 Winfield Rd Ste 200
Warrenville, IL 60555-4023
Phone
(224) 760-9754
NPI assigned
May 5, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2023

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

Authorized official

Name
Dr. Jason Morris, PSYDNPI 1447529789
Title
Owner
Phone
(224) 760-9754

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 5

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X Primary
Adult Development & Aging PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TA0700X
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X
Counseling PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC1900X
Health PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TH0004X

Addresses

Primary practice location

4320 Winfield Rd Ste 200
Warrenville, IL 60555-4023

Mailing address

4320 Winfield Rd Ste 200
Warrenville, IL 60555-4023
Phone (224) 760-9754

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, MO, IN3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20201013002070 IL Part B Supplier - Clinic/Group Practice 9335569342 Receives reassigned benefits from 1 practitioner
Practice locations: Warrenville, IL
O20201029002790 MO Part B Supplier - Clinic/Group Practice 9335569342 Receives reassigned benefits from 1 practitioner
Practice locations: Glasgow, MO
O20211018000294 IN Part B Supplier - Clinic/Group Practice 9335569342 Receives reassigned benefits from 1 practitioner
Practice locations: South Bend, IN

National Provider Directory

National Provider Directory

Locations

608 1st St
Ste B
Glasgow, MO 65254
Phone (224) 760-9754

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1588636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676505600000",
    "number": "1407477052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4320 WINFIELD RD STE 200",
            "city": "WARRENVILLE",
            "state": "IL",
            "postal_code": "605554023",
            "telephone_number": "224-760-9754",
            "fax_number": "224-351-1121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4320 WINFIELD RD STE 200",
            "city": "WARRENVILLE",
            "state": "IL",
            "postal_code": "605554023",
            "telephone_number": "224-760-9754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLATINUM PSYCHOLOGY SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-05",
        "last_updated": "2023-02-16",
        "certification_date": "2023-02-16",
        "status": "A",
        "authorized_official_last_name": "MORRIS",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "224-760-9754",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TA0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Adult Development & Aging",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warrenville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 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.