Anna R Basov, PSYD, LCPC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071009153 Issued in IL

Practice address

601 Skokie Blvd
Suite #LL-5D
Northbrook, IL 60062-2851

Phone

(847) 607-1589

Fax

(847) 881-0839

NPI assigned

Aug 7, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

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, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Center for Psychology and Wellness, P.C.Group PAC ID 2062713803, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Center for Psychology and Wellness, P.C.

  • Psychologist
  • Northbrook, IL
  • NPI 1194113357
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1344297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445990400000",
    "number": "1487901609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 SKOKIE BOULEVARD",
            "address_2": "SUITE #LL-5D",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600602813",
            "telephone_number": "847-607-1589",
            "fax_number": "847-881-0839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 SKOKIE BLVD",
            "address_2": "SUITE #LL-5D",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600622851",
            "telephone_number": "847-607-1589",
            "fax_number": "847-881-0839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASOV",
        "first_name": "ANNA",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "PSYD, LCPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-08-07",
        "last_updated": "2015-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.009063",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "178.007955",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071009153",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Denise Amelia Bartolo Smith, LPC
• Stephanie Barton, RBT-21-159870
• Sara Bartus, LCSW
• Brian Ethan Baruck, LPC
• Warren Baskin, DC
• Amee Elenore Bass, M.D.
• Zehra Batool, RBT-18-70423
• Lauren Michelle Bauer, LSW
• Nicole Marie Bauknecht, PA-C
• Maria Baulding

• Clinical Psychologist in Northbrook, IL
• Providers in Northbrook, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2015; 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.