Michael Joseph Gillen, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

3313-57 Issued in WI

Practice address

21425 Spring Street
Union Grove VA Clinic
Union Grove, WI 53182

Phone

(262) 878-7020

NPI assigned

Oct 21, 2015

Last updated

Nov 15, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Clinical Psychologist

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Davken Associates, P.C.Group PAC ID 8820901861, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Davken Associates, P.C.

  • Clinical Psychologist
  • Deerfield, IL
  • NPI 1457393159
  Medicare reassignment Care Compare group
• PHC of Buffalo Grove Nutrition

  dba Portrait Health Centers

  • Registered Dietitian
  • Vernon Hills, IL
  • NPI 1902107386
  NPD (past)

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

{
    "created_epoch": "1445385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700006400000",
    "number": "1477925121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21425 SPRING STREET",
            "address_2": "UNION GROVE VA CLINIC",
            "city": "UNION GROVE",
            "state": "WI",
            "postal_code": "53182",
            "telephone_number": "262-878-7020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21425 SPRING STREET",
            "address_2": "UNION GROVE VA CLINIC",
            "city": "UNION GROVE",
            "state": "WI",
            "postal_code": "53182",
            "telephone_number": "262-878-7020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLEN",
        "first_name": "MICHAEL",
        "middle_name": "JOSEPH",
        "name_prefix": "Mr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-10-21",
        "last_updated": "2023-11-15",
        "certification_date": "2023-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "3313-57",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Allison Epping
• Taryn Kline Fernandes, MD
• Kristin Fields
• Amanda Fontenot, DPT
• Gallina Health Care Network, LTD (Timber Oaks)
• Harley Glodowski, LPC
• Julie Ann Gotsch, CMHC- MS, LPC-IT
• Maria Graham
• Stephen E Graham, D.V.M.
• H.O.P.E. Day Services LLC

• Clinical Psychologist in Union Grove, WI
• Providers in Union Grove, WI by specialty
• Clinical Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.