Individual provider Active NPI

Tracy Fehrenbach, PH.D.

  • Clinical Psychologist
  • Chicago, IL
National Provider Identifier
1699000125
Registry record updated Oct 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071006910 Issued in IL
Practice address
446 E Ontario St Ste 7-100
Chicago, IL 60611-4418
Phone
(312) 695-5060
Fax
(312) 695-5010
NPI assigned
Oct 16, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 1, 2018

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 071006910 IL Primary

Addresses

Primary practice location

446 E Ontario St Ste 7-100
Chicago, IL 60611-4418

Mailing address

3330 W 177TH St
Suite 1-F
Hazel Crest, IL 60429-2184
Phone (773) 573-5847

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
I20100114000748 IL Practitioner - Clinical Psychologist 4880736792 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

Practice addresses (Care Compare)

446 E Ontario St
100 Dept of Psychiatry
Chicago, IL 60611-4418
Phone (312) 695-5060

Merit-based Incentive Payment System (MIPS)

Final score
95.19 of 100Reported as apm
Quality
83.05
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince Nov 1, 2018 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Nov 1, 2018 Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

446 E Ontario St
Ste 7100
Chicago, IL 60611
Phone (312) 926-8058

680 N Lake Shore Dr
Ste 1000
Chicago, IL 60611
Phone (312) 695-4022

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

Organizations & group practices 2

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": "1255651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538352000000",
    "number": "1699000125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3330 W 177TH ST",
            "address_2": "SUITE 1-F",
            "city": "HAZEL CREST",
            "state": "IL",
            "postal_code": "604292184",
            "telephone_number": "773-573-5847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "446 E ONTARIO ST STE 7-100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606114418",
            "telephone_number": "312-695-5060",
            "fax_number": "312-695-5010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEHRENBACH",
        "first_name": "TRACY",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-10-16",
        "last_updated": "2018-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071006910",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.