Individual provider Active NPI

Susan Elizabeth Bennett, PHD

  • Clinical Psychologist
  • Schaumburg, IL
National Provider Identifier
1477529287
Registry record updated Nov 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071005508 Issued in IL
Practice address
919 N Plum Grove Rd
Suite C
Schaumburg, IL 60173-5144
Phone
(847) 413-9700
Fax
(847) 413-1701
NPI assigned
Feb 23, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2012

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 071005508 IL Primary

Addresses

Primary practice location

919 N Plum Grove Rd
Suite C
Schaumburg, IL 60173-5144

Mailing address

919 N Plum Grove Rd
Suite C
Schaumburg, IL 60173-5144
Phone (847) 413-9700

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
I20050408000657 IL Practitioner - Clinical Psychologist 5597702852 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Saint Louis University School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Personal Growth Associates, Inc.Group PAC ID 8921058140, 13 clinicians

Practice addresses (Care Compare)

919 N Plum Grove Rd
Suite C
Schaumburg, IL 60173-4760
Phone (847) 413-9700

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
071005508ILMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Personal Growth Associates, Inc. CurrentSince Feb 1, 2004 Accepting new patients

Locations

820 E Terra Cotta Ave
Crystal Lake, IL 60014
Phone (815) 444-1330

919 N Plum Grove Rd
Ste C
Schaumburg, IL 60173
Phone (847) 413-9700

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": "1140652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352332800000",
    "number": "1477529287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "919 N PLUM GROVE RD",
            "address_2": "SUITE C",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601735144",
            "telephone_number": "847-413-9700",
            "fax_number": "847-413-1701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "919 N PLUM GROVE RD",
            "address_2": "SUITE C",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601735144",
            "telephone_number": "847-413-9700",
            "fax_number": "847-413-1701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "SUSAN",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-23",
        "last_updated": "2012-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071005508",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Schaumburg, IL

Sources for this page

Verify at the official NPI Registry.