Active NPI
Aaron Poppy
- Psychologist
- Bloomington, IL
National Provider Identifier
1518115682
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 071.009670
- Practice address
- 207 W Jefferson St Ste 402
Bloomington, IL 61701-3969 - Phone
- (309) 520-2265
- NPI assigned
- Sep 3, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 071.009670 | IL | Primary |
Addresses
Primary practice location
207 W Jefferson St Ste 402
Bloomington, IL 61701-3969
Mailing address
808 S Eldorado Rd Ste 102
Bloomington, IL 61704-6075
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180207000598 | IL | Practitioner - Clinical Psychologist | 7012277346 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071.009670 | IL | MD | Psychologist |
Interoperability endpoints
- lifestancehealth.aaronpoppy@146897.advancedmd-direct.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1220400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706227200000",
"number": "1518115682",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "808 S ELDORADO RD STE 102",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617046075"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "207 W JEFFERSON ST STE 402",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617013969",
"telephone_number": "309-520-2265"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POPPY",
"first_name": "AARON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-09-03",
"last_updated": "2024-01-26",
"certification_date": "2024-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "IL",
"license": "071.009670",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2024; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.