Tristate Wellness MGT LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

036093462 Issued in IL

Legal business name

TRISTATE WELLNESS MGT LLC

Practice address

2826 N Talman
Unit J
Chicago, IL 60618-7828

Phone

(708) 646-5738

Fax

(866) 587-1485

NPI assigned

May 23, 2006

Organization subpart

No

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

Authorized official

Name

Philip Douglas Thompson

Title

Program Director

Phone

(708) 646-5738

Specialties & licenses 2

Addresses

Other identifiers 2

Practitioners 2

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

• Hany M Girgis, PH.D.

  • Clinical Psychologist
  • Kankakee, IL
  • NPI 1306016647
  NPD (past)
• Walter C Wrobel, MD

  • General Practice Physician
  • Arlington HTS, IL
  • NPI 1215936406
  NPD (past)

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199750400000",
    "number": "1609821164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2826 N TALMAN",
            "address_2": "UNIT J",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606187828",
            "telephone_number": "708-646-5738",
            "fax_number": "866-587-1485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2826 N TALMAN",
            "address_2": "UNIT J",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606187828",
            "telephone_number": "708-646-5738",
            "fax_number": "866-587-1485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRISTATE WELLNESS MGT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2008-01-08",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "DOUGLAS",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "708-646-5738"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "336-008797",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "036093462",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036039387",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036093462",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Triskele Rehabilitation & Performance PLLC
• Jenny Michelle Tristano, MD
• Trisys Medical Group
• Jenna Tritsch
• Michael Robert Tritt, MD
• Triumph Community Services
• Triumph Seminars

• Clinical Psychologist in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.