Individual provider Active NPI

Pedro Juan Carlos Segura-Moore, ALMFT

  • Marriage & Family Therapist
  • Chicago, IL
National Provider Identifier
1497505598
Registry record updated Mar 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
208.001078 Issued in IL
Practice address
5554 S Hyde Park Blvd
Chicago, IL 60637-1909
Phone
(773) 345-8330
NPI assigned
Mar 25, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 208.001078 IL Primary

Addresses

Primary practice location

5554 S Hyde Park Blvd
Chicago, IL 60637-1909

Mailing address

5554 S Hyde Park Blvd
Chicago, IL 60637-1909
Phone (703) 458-3307

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
208.001078ILMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Modern Insight Therapy PLLC Past Accepting new patients

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": "1711324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711324800000",
    "number": "1497505598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5554 S HYDE PARK BLVD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606371909",
            "telephone_number": "703-458-3307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5554 S HYDE PARK BLVD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606371909",
            "telephone_number": "773-345-8330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEGURA-MOORE",
        "first_name": "PEDRO",
        "middle_name": "JUAN CARLOS",
        "name_prefix": "Mr.",
        "credential": "ALMFT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-03-25",
        "last_updated": "2024-03-25",
        "certification_date": "2024-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "IL",
            "license": "208.001078",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.