Active NPI
Daniel Aron Goldberg, PSY.D.
- Clinical Psychologist
- Lake Villa, IL
National Provider Identifier
1699163410
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071008898
- Practice address
- 600 West Grand Avenue
Lake Villa, IL 60046 - Phone
- (847) 245-6337
- NPI assigned
- Dec 31, 2014
- Last updated
- Dec 31, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 071008898 | IL | Primary |
Addresses
Primary practice location
600 West Grand Avenue
Lake Villa, IL 60046
Mailing address
525 Autumn Blvd
Unit 102
Lakemoor, IL 60051-6690
Phone (630) 251-8762
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200214001911 | IL | Practitioner - Clinical Psychologist | 1153757927 | Practice locations: Waukegan, IL |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
1100 S Lewis Ave
Waukegan, IL 60085-7710
Phone (847) 244-8196
8170 McCormick Blvd
Suite 204
Skokie, IL 60076-2920
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071008898 | IL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1419984000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1419984000000",
"number": "1699163410",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "525 AUTUMN BLVD",
"address_2": "UNIT 102",
"city": "LAKEMOOR",
"state": "IL",
"postal_code": "600516690",
"telephone_number": "630-251-8762"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 WEST GRAND AVENUE",
"city": "LAKE VILLA",
"state": "IL",
"postal_code": "60046",
"telephone_number": "847-245-6337"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLDBERG",
"first_name": "DANIEL",
"middle_name": "ARON",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-12-31",
"last_updated": "2014-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071008898",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Villa, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 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.