Active NPI
Rebekah Lee Fuller Fricke, PSYD
- Clinical Psychologist
- Champaign, IL
National Provider Identifier
1568763977
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071008014
- Practice address
- 100 N Chestnut St Ste 244
Champaign, IL 61820-4856 - Phone
- (217) 621-6180
- NPI assigned
- Nov 16, 2010
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 071008014 | IL | Primary |
Addresses
Primary practice location
100 N Chestnut St Ste 244
Champaign, IL 61820-4856
Mailing address
PO Box 2257
Chesterton, IN 46304-0357
Phone (219) 926-8320
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 14, 2020 through Jul 14, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071008014 | IL | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Teladoc Health Medical Group, P.a. | Current | Accepting new patients |
Interoperability endpoints
- rebekahfricke@tdh.allscriptsdirect.net
Organizations & group practices 1
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.
-
- Family Medicine Physician
- Lewisville, TX
- NPI 1245403567
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1289865600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473292800000",
"number": "1568763977",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2257",
"city": "CHESTERTON",
"state": "IN",
"postal_code": "463040357",
"telephone_number": "219-926-8320",
"fax_number": "219-926-3524"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 N CHESTNUT ST STE 244",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618204856",
"telephone_number": "217-621-6180"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLER FRICKE",
"first_name": "REBEKAH",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-11-16",
"last_updated": "2016-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071008014",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Champaign, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.