Andrew Vincent Shack, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071-006231 Issued in IL

Practice address

1103 Westgate St
Suite 200
Oak Park, IL 60301-1088

Phone

(708) 386-8112

Fax

(708) 383-4298

NPI assigned

May 25, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Clinical Psychologist

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Aspen Behavioral Care

  • Psychologist
  • Arlington HTS, IL
  • NPI 1093761439

  Clinical

  NPD (past)

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393459200000",
    "number": "1659327229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1103 WESTGATE ST",
            "address_2": "SUITE 200",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603011088",
            "telephone_number": "708-386-8112",
            "fax_number": "708-383-4298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1103 WESTGATE ST",
            "address_2": "SUITE 200",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603011088",
            "telephone_number": "708-386-8112",
            "fax_number": "708-383-4298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHACK",
        "first_name": "ANDREW",
        "middle_name": "VINCENT",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-25",
        "last_updated": "2014-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071-006231",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexander Serrano, LCSW
• Lizbeth Alexa Serrano
• Ankur Sethi, MD
• Jessica Setlak, APN
• Rasheedah Shabazz
• Tatyana Shafiro
• J P Shaft, LCSW
• Alison Hanold Shah
• Jahanvi Shah
• Maimoona Shah, M.D.

• Clinical Psychologist in Oak Park, IL
• Providers in Oak Park, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2014; 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.