Jerry Gibbons, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

336072265 Issued in IL

Practice address

1001 Rohlwing Rd
Elk Grove Village, IL 60007-3217

Phone

(847) 524-8800

Fax

(847) 524-8824

NPI assigned

Aug 17, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1994

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Kenneth Young CenterGroup PAC ID 7416940655, 23 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Alexian Brothers Medical Center 1 Hospital, Elk Grove Village, IL, CCN 140258
• Northwest Community Hospital 1 Hospital, Arlington Heights, IL, CCN 140252

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kenneth Young Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Elk Grove Village, IL
  • NPI 1629083241

  IL

  Medicare reassignment Care Compare group NPD
• Jo Wolthusen, PSYD PC

  • Clinical Psychologist
  • Palatine, IL
  • NPI 1427309392
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Alexian Brothers Medical Center

  • General Acute Care Hospital
  • Elk Grove Village, IL
  • NPI 1265577191

  Hospital

  Care Compare affiliation
• Northwest Community Hospital

  • General Acute Care Hospital
  • Arlington Heights, IL
  • NPI 1578932869

  Hospital

  Care Compare affiliation
• Northwest Community Hospital

  • General Acute Care Hospital
  • Arlington Heights, IL
  • NPI 1770531600

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339459200000",
    "number": "1619080124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 ROHLWING RD",
            "city": "ELK GROVE VILLAGE",
            "state": "IL",
            "postal_code": "600073217",
            "telephone_number": "847-524-8800",
            "fax_number": "847-524-8824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 ROHLWING RD",
            "city": "ELK GROVE VILLAGE",
            "state": "IL",
            "postal_code": "600073217",
            "telephone_number": "847-524-8800",
            "fax_number": "847-524-8824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBBONS",
        "first_name": "JERRY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-17",
        "last_updated": "2012-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "336072265",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0081646688",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0071648971",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0021622840",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anne A Gephart Moore, PSY D
• Scott Ryan Geraghty, MD
• Elizabeth Gerson, ANP
• Patricia Gessner, APN, CNP
• Bassem Ghaly, M.D.
• Sanem Gill
• Gianna Lynnea Giuliani, M.S. CCC SLP
• Nicole Glaser
• Christopher William Glatt
• Charlotte Peiwha Glenn, MD

• Psychiatry Physician in Elk Grove Village, IL
• Providers in Elk Grove Village, IL by specialty
• Psychiatry Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2012; 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.

Verify at the official NPI Registry.