Kim Marie Gorecki, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2810-057 Issued in WI

Practice address

19275 W Capitol Dr Ste 200
Brookfield, WI 53045-2734

Phone

(262) 546-7478

Fax

(262) 373-0362

NPI assigned

Sep 27, 2006

Last updated

Jan 21, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Kim Marie Anderson Other name

Medicare fee-for-service enrollment

Enrolled in WI

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

Specialty

Clinical Psychologist

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Gorecki Psychological Services LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Brookfield, WI
  • NPI 1083170732
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548028800000",
    "number": "1649361775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19275 W CAPITOL DR STE 200",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530452734",
            "telephone_number": "262-546-7478",
            "fax_number": "262-373-0362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19275 W CAPITOL DR STE 200",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530452734",
            "telephone_number": "262-546-7478",
            "fax_number": "262-373-0362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORECKI",
        "first_name": "KIM",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-27",
        "last_updated": "2019-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "2810-057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LP",
            "identifier": "2810-057",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIM",
            "last_name": "ANDERSON",
            "middle_name": "MARIE",
            "prefix": "DR.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Lawrence A Golopol, MD
• Peter James Gonzalez, D.C.
• Serena Goodbear
• Emma Gooding
• Gorecki Psychological Services LLC
• Michael P Goss, MD
• Khushi Goyal
• Kathryn Gradecki
• Eva Graham
• Jessica L Grams, DDS

• Clinical Psychologist in Brookfield, WI
• Providers in Brookfield, WI by specialty
• Clinical Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2019; 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.