Individual provider Active NPI

Linda Louise Lake, PSY.D.

  • Clinical Psychologist
  • Hinsdale, IL
National Provider Identifier
1679637672
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Practice address
120 E Ogden Ave
Suite 220
Hinsdale, IL 60521-3542
Phone
(630) 325-5300
Fax
(630) 325-5309
NPI assigned
Dec 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X IL Primary

Addresses

Primary practice location

120 E Ogden Ave
Suite 220
Hinsdale, IL 60521-3542

Mailing address

120 E Ogden Ave
Suite 220
Hinsdale, IL 60521-3542
Phone (630) 325-5300

Other identifiers 1

IdentifierTypeStateIssuer
02215636OtherILBLUE CROSS BLUE SHIELD

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
I20051114000405 IL Practitioner - Clinical Psychologist 0648299271 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Heritage Professional Associates LTDGroup PAC ID 6002707262, 18 clinicians

Practice addresses (Care Compare)

120 E Ogden Ave
Hinsdale, IL 60521-3546
Phone (630) 325-5300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
071-006791ILMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Heritage Professional Associates LTD CurrentSince Jan 23, 2016 Accepting new patients

Locations

120 E Ogden Ave
Ste 220
Hinsdale, IL 60521
Phone (630) 325-5300

120 E Ogden Ave
Ste 2
Hinsdale, IL 60521
Phone (630) 325-5300

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.

NPI Registry JSON

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

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679637672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 E OGDEN AVE",
            "address_2": "SUITE 220",
            "city": "HINSDALE",
            "state": "IL",
            "postal_code": "605213542",
            "telephone_number": "630-325-5300",
            "fax_number": "630-325-5309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 E OGDEN AVE",
            "address_2": "SUITE 220",
            "city": "HINSDALE",
            "state": "IL",
            "postal_code": "605213542",
            "telephone_number": "630-325-5300",
            "fax_number": "630-325-5309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "LINDA",
        "middle_name": "LOUISE",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "02215636",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hinsdale, IL

Sources for this page

Verify at the official NPI Registry.