Active NPI
Jeffrey Gallant Wapner, PH.D.
- Clinical Psychologist
- Willowbrook, IL
National Provider Identifier
1558502906
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 008511-1
- Practice address
- 50 75TH St
Suite 212
Willowbrook, IL 60527-2393 - Phone
- (914) 329-4185
- NPI assigned
- Mar 16, 2009
- Last updated
- May 31, 2013
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 008511-1 | NY | Primary |
| Clinical Psychologist | 103TC0700X | 071.008571 | IL |
Addresses
Primary practice location
50 75TH St
Suite 212
Willowbrook, IL 60527-2393
Mailing address
7213 Bateman St
Downers Grove, IL 60516-3793
Phone (914) 329-4185
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 |
|---|---|---|---|---|
| I20141230001797 | IL | Practitioner - Clinical Psychologist | 6709109531 | Practice locations: Willowbrook, IL |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Fordham University School of Medicine, 1984
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
50 75TH St
Suite 212
Willowbrook, IL 60527-2384
Phone (914) 329-4185
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071.008571 | IL | MD | Clinical Psychologist |
| 008511-1 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1237161600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1369958400000",
"number": "1558502906",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7213 BATEMAN ST",
"city": "DOWNERS GROVE",
"state": "IL",
"postal_code": "605163793",
"telephone_number": "914-329-4185"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "50 75TH ST",
"address_2": "SUITE 212",
"city": "WILLOWBROOK",
"state": "IL",
"postal_code": "605272393",
"telephone_number": "914-329-4185"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAPNER",
"first_name": "JEFFREY",
"middle_name": "GALLANT",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-03-16",
"last_updated": "2013-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "008511-1",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071.008571",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Willowbrook, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2013; 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.