Active NPI
Jennifer Lynn Kurth, DO
- Psychiatry Physician
- Northbrook, IL
National Provider Identifier
1669524369
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 036113283
- Practice address
- 60 Revere Dr Ste 100
Northbrook, IL 60062-1590 - Phone
- (773) 301-7476
- NPI assigned
- Jan 16, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 036113283 | IL | Primary |
| Child & Adolescent Psychiatry Physician | 2084P0804X | 036113283 | IL |
Addresses
Primary practice location
60 Revere Dr Ste 100
Northbrook, IL 60062-1590
Mailing address
60 Revere Dr Ste 100
Northbrook, IL 60062-1590
Phone (773) 301-7476
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036113283 | Other | IL | ILLINOIS STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Mar 1, 2015 through Mar 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lurie Children's Medical Group | Child & Adolescent Psychiatry | Past | Accepting new patients |
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 and National Provider Directory roles.
-
dba LCMG Specialty Services
- Child & Adolescent Psychiatry Physician
- Chicago, IL
- NPI 1518033836
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1423612800000",
"number": "1669524369",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "60 REVERE DR STE 100",
"city": "NORTHBROOK",
"state": "IL",
"postal_code": "600621590",
"telephone_number": "773-301-7476"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "60 REVERE DR STE 100",
"city": "NORTHBROOK",
"state": "IL",
"postal_code": "600621590",
"telephone_number": "773-301-7476"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KURTH",
"first_name": "JENNIFER",
"middle_name": "LYNN",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-16",
"last_updated": "2015-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "IL",
"license": "036113283",
"primary": true
},
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "IL",
"license": "036113283",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ILLINOIS STATE LICENSE",
"identifier": "036113283",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Northbrook, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2015; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.