Individual provider Active NPI

Laura Marie Van Dusen, MD

  • Psychiatry Physician
  • Park Ridge, IL
National Provider Identifier
1710072996
Registry record updated May 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
036103137 Issued in IL
Practice address
1440 Renaissance Dr
Suite 200
Park Ridge, IL 60068-1472
Phone
(847) 296-3442
Fax
(847) 296-3543
NPI assigned
Oct 4, 2006
Last updated
May 13, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 036103137 IL Primary

Addresses

Primary practice location

1440 Renaissance Dr
Suite 200
Park Ridge, IL 60068-1472

Mailing address

1440 Renaissance Dr
Suit 200
Park Ridge, IL 60068-1472
Phone (847) 296-3442

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: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040121000019 IL Practitioner - Psychiatry 0941102032 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Rush Medical College of Rush University, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1440 Renaissance Dr
Suite 220
Park Ridge, IL 60068-1452
Phone 847296344212

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036103137ILMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Laura Van Dusen M.D. S.C. Psychiatry CurrentSince Jan 1, 2007 Accepting new patients

Locations

6615 Grand Ave
Gurnee, IL 60031
Phone (224) 208-8266

1440 Renaissance Dr
Ste 200
Park Ridge, IL 60068
Phone (847) 296-3442

1440 Renaissance Dr
Ste 220
Park Ridge, IL 60068
Phone (847) 296-3442

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

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1368403200000",
    "number": "1710072996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1440 RENAISSANCE DR",
            "address_2": "SUIT 200",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681472",
            "telephone_number": "847-296-3442",
            "fax_number": "847-296-3543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1440 RENAISSANCE DR",
            "address_2": "SUITE 200",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681472",
            "telephone_number": "847-296-3442",
            "fax_number": "847-296-3543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DUSEN",
        "first_name": "LAURA",
        "middle_name": "MARIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2013-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036103137",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Park Ridge, IL

Sources for this page

Verify at the official NPI Registry.