Active NPI
Jaci Bergles
- Child & Adolescent Psychiatry Physician
- Northbrook, IL
National Provider Identifier
1497590087
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child & Adolescent Psychiatry Physician
- License
- 2084P0804X
- Practice address
- 4201 Lake Cook Rd Ste 2004201
Northbrook, IL 60062-1060 - Phone
- (847) 565-8999
- NPI assigned
- Jun 26, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Child & Adolescent Psychiatry Physician | 2084P0804X | 2084P0804X | IL | Primary |
Addresses
Primary practice location
4201 Lake Cook Rd Ste 2004201
Northbrook, IL 60062-1060
Mailing address
4201 Lake Cook Rd Ste 200
Northbrook, IL 60062-1060
Phone (847) 565-8999
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
| License | State | Type | Specialty |
|---|---|---|---|
| 2084P0804X | IL | MD | Child & Adolescent Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1719360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719360000000",
"number": "1497590087",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4201 LAKE COOK RD STE 200",
"city": "NORTHBROOK",
"state": "IL",
"postal_code": "600621060",
"telephone_number": "847-565-8999"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4201 LAKE COOK RD STE 2004201",
"city": "NORTHBROOK",
"state": "IL",
"postal_code": "600621060",
"telephone_number": "847-565-8999"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGLES",
"first_name": "JACI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-06-26",
"last_updated": "2024-06-26",
"certification_date": "2024-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "IL",
"license": "2084P0804X",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Northbrook, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 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.