Active NPI
Rana Gordon, PHD
- Psychologist
- Evanston, IL
National Provider Identifier
1558477612
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- Practice address
- 708 Church St
Suite 250
Evanston, IL 60201 - Phone
- (847) 869-5955
- Fax
- (847) 869-0021
- NPI assigned
- Aug 22, 2006
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | IL | Primary |
Addresses
Primary practice location
708 Church St
Suite 250
Evanston, IL 60201
Mailing address
2529 Greeley Ave
Evanston, IL 60201
Phone (847) 869-6432
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0001673052 | Other | BLUE CROSS BLUE SHIELD IL |
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 |
|---|---|---|---|---|
| I20110916000305 | IL | Practitioner - Clinical Psychologist | 2466623756 | Practice locations: Evanston, IL |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1979
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
708 Church St
Evanston, IL 60201-3840
Phone (847) 869-5955
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071002648 | IL | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156204800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1558477612",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2529 GREELEY AVE",
"city": "EVANSTON",
"state": "IL",
"postal_code": "60201",
"telephone_number": "847-869-6432",
"fax_number": "847-869-0021"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "708 CHURCH ST",
"address_2": "SUITE 250",
"city": "EVANSTON",
"state": "IL",
"postal_code": "60201",
"telephone_number": "847-869-5955",
"fax_number": "847-869-0021"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "RANA",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD IL",
"identifier": "0001673052",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Evanston, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.