Individual provider Active NPI

Debra J Jedd, PSYD

  • Psychologist
  • Champaign, IL
National Provider Identifier
1659303063
Registry record updated May 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
071006849 Issued in IL
Practice address
1813 W. Kirby Avenue
Psychiatry/Psychology
Champaign, IL 61821
Phone
(217) 383-1850
Fax
(217) 383-3439
NPI assigned
Jul 7, 2006
Last updated
May 26, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 26, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 071006849 IL Primary

Addresses

Primary practice location

1813 W. Kirby Avenue
Psychiatry/Psychology
Champaign, IL 61821

Mailing address

611 W Park St
BWPC
Urbana, IL 61801-2529
Phone (217) 383-6792

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
I20050608000182 IL Practitioner - Clinical Psychologist 5193768414 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Carle Health Care IncorporatedGroup PAC ID 3577515774, 1,592 clinicians

Practice addresses (Care Compare)

1802 S Mattis Ave
Champaign, IL 61821-5923
Phone (217) 326-1330

611 W Park St
Urbana, IL 61801-2501
Phone (888) 712-2753

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
071006849ILMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Carle Health Medical Group CurrentSince Apr 1, 2010 Accepting new patients

Locations

1813 W Kirby Ave
Champaign, IL 61821
Phone (217) 383-1850

1802 S Mattis Ave
Champaign, IL 61821
Phone (217) 365-2855

1001 Heather Dr
Mahomet, IL 61853
Phone (217) 586-2317

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1432598400000",
    "number": "1659303063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W PARK ST",
            "address_2": "BWPC",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618012529",
            "telephone_number": "217-383-6792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1813 W. KIRBY AVENUE",
            "address_2": "PSYCHIATRY/PSYCHOLOGY",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "61821",
            "telephone_number": "217-383-1850",
            "fax_number": "217-383-3439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEDD",
        "first_name": "DEBRA",
        "middle_name": "J",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-07",
        "last_updated": "2015-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IL",
            "license": "071006849",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Champaign, IL

Sources for this page

Verify at the official NPI Registry.