Jackson I Newberry III

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

201 E Park St Ste B
Mundelein, IL 60060-1973

Phone

(847) 262-4393

NPI assigned

Nov 19, 2017

Last updated

Nov 19, 2017By 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 FL

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, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Silver Palm Health Psych LLCGroup PAC ID 6901301779, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Networks

• Freedom Health HMO Network

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.

• Silver Palm Health Psych LLC

  • Clinical Psychologist
  • Sunny Isles Beach, FL
  • NPI 1992592786
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1511049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1511049600000",
    "number": "1538673116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3750 MERRIMAC LN W",
            "city": "HANOVER PARK",
            "state": "IL",
            "postal_code": "601336258",
            "telephone_number": "630-267-2885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 E PARK ST STE B",
            "city": "MUNDELEIN",
            "state": "IL",
            "postal_code": "600601973",
            "telephone_number": "847-262-4393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEWBERRY",
        "first_name": "JACKSON",
        "middle_name": "I",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-11-19",
        "last_updated": "2017-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• National Vision Inc (America's Best Contacts & Eyeglasses)
• Navid Kia Ddsps
• NE Healthcare Agency, Inc
• Kathleen Nestingen, DC
• Neurobehavioral Health Connections, LTD
• Nina Neyman, M.D.
• Inetta V Nikogosian, DN
• Joann Kendrick Nishimoto, PSY.D.
• Mary Nissen, OTR/L
• North Star Counseling Group, LLC

• Counselor in Mundelein, IL
• Providers in Mundelein, IL by specialty
• Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2017; 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.