Individual provider Active NPI

Anne H. Wiley, PH.D.

  • Clinical Neuropsychologist
  • Chicago, IL
National Provider Identifier
1619090719
Registry record updated Apr 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
71007245 Issued in IL
Practice address
4327 N Bell Ave
Chicago, IL 60618-1609
Phone
(773) 866-2818
NPI assigned
Apr 6, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 8, 2015

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X 71007245 IL Primary
Clinical Psychologist 103TC0700X 71007245 IL
Health Psychologist 103TH0004X
Rehabilitation Psychologist 103TR0400X

Addresses

Primary practice location

4327 N Bell Ave
Chicago, IL 60618-1609

Mailing address

4327 N Bell Ave
Chicago, IL 60618-1609
Phone (773) 866-2818

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070523000044 IL Practitioner - Clinical Psychologist 2163529322 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Neurobehavioral Associates PCGroup PAC ID 2466551379, 3 clinicians

Practice addresses (Care Compare)

10730 W 143Rd St
Suite 37
Orland Park, IL 60462-1940
Phone (800) 564-0863

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
71007245ILMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Aspen Behavioral Care Clinical Neuropsychologist PastSince Jul 31, 2013 Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428451200000",
    "number": "1619090719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4327 N BELL AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606181609",
            "telephone_number": "773-866-2818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4327 N BELL AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606181609",
            "telephone_number": "773-866-2818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILEY",
        "first_name": "ANNE",
        "middle_name": "H.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-06",
        "last_updated": "2015-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "IL",
            "license": "71007245",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "71007245",
            "primary": false
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TR0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.