Shirley Butler, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071005527 Issued in IL

Practice address

1627 W Colonial Pkwy Ste 205
Inverness, IL 60067-4732

Phone

(847) 977-4610

Fax

(847) 229-1987

NPI assigned

Oct 5, 2006

Last updated

Sep 5, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

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

• Donald L Fagerson MD SC

  • Psychiatry Physician
  • Inverness, IL
  • NPI 1497877963
  NPD (past)

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567641600000",
    "number": "1669568689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1627 W COLONIAL PKWY STE 205",
            "city": "INVERNESS",
            "state": "IL",
            "postal_code": "600674732",
            "telephone_number": "847-977-4610",
            "fax_number": "847-229-1987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1627 W COLONIAL PKWY STE 205",
            "city": "INVERNESS",
            "state": "IL",
            "postal_code": "600674732",
            "telephone_number": "847-977-4610",
            "fax_number": "847-229-1987"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1644 W Colonial Pkwy",
            "address_purpose": "LOCATION",
            "city": "Inverness",
            "state": "IL",
            "postal_code": "600671207",
            "country_code": "US",
            "telephone_number": "847-776-4500 x311",
            "fax_number": "847-776-4724",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUTLER",
        "first_name": "SHIRLEY",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-05",
        "last_updated": "2019-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071005527",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHD",
            "identifier": "071005527",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Sbutler106@aol.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1627 W Colonial Pkwy Ste 205",
            "city": "Inverness",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600674732",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Valerie A Bond, MA, LPCP
• Susan Jean Brach
• Bravo Care of Inverness Inc (Rosewood Care Center of Inverness)
• Brennan Counseling, P.C.
• Thomas Ralph Bruno, M.D.
• Janine Cangialosi, LCPC
• Celeste Genevieve Counseling, PLLC
• Mingyeong Choe
• Kristen Christensen
• Jason Cockfield, LMT

• Clinical Psychologist in Inverness, IL
• Providers in Inverness, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 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.