Family Child & Adolescent Psychiatric Services SC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

036067468 Issued in IL

Legal business name

FAMILY CHILD & ADOLESCENT PSYCHIATRIC SERVICES SC

Practice address

1 Old Frankfort Way
Frankfort, IL 60423-1719

Phone

(708) 206-1300

Fax

(708) 206-1399

NPI assigned

Oct 26, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Mila B Aquino

Title

Medical Billing Service

Phone

(951) 282-0060

Specialties & licenses 1

Addresses

Other identifiers 9

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Clara T Perez, MD

  • Psychiatry Physician
  • Frankfort, IL
  • NPI 1316906464
  Medicare reassignment NPD
• Stanley Selinger, PH.D.

  • Clinical Psychologist
  • Flossmoor, IL
  • NPI 1063490795
  NPD (past)

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620691200000",
    "number": "1598840936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "833 W 15TH PL",
            "address_2": "UNIT 815",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606081429",
            "telephone_number": "708-206-1300",
            "fax_number": "708-206-1399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 OLD FRANKFORT WAY",
            "city": "FRANKFORT",
            "state": "IL",
            "postal_code": "604231719",
            "telephone_number": "708-206-1300",
            "fax_number": "708-206-1399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY CHILD & ADOLESCENT PSYCHIATRIC SERVICES SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2021-05-11",
        "certification_date": "2021-05-11",
        "status": "A",
        "authorized_official_last_name": "AQUINO",
        "authorized_official_first_name": "MILA",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "MEDICAL BILLING SERVICE",
        "authorized_official_telephone_number": "951-282-0060",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036067468",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMPSYCH PROVIDER #",
            "identifier": "119475",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE #",
            "identifier": "036067468",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PSYCHEALTH PROVIDER #",
            "identifier": "155000",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARMONY PROVIDER #",
            "identifier": "166548",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUEOPTIONS PROVIDER #",
            "identifier": "018896",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036067468",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "3103879",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER #",
            "identifier": "31603879",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAID PROVIDER #",
            "identifier": "35928",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychiatry Physician in Frankfort, IL
• Providers in Frankfort, IL by specialty
• Psychiatry Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.