Kamilah Banks Word
Individual provider Active NPI Psychiatry Physician · Harvey, IL
NPI 1720405129 · NPPES record last updated Jun 10, 2022
Key facts
- NPI
- 1720405129
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatry Physician 2084P0800X
- License
- 1720405129 (IL)
- Practice address
- 31 W 155TH St
Harvey, IL 60426-3556 - Phone
- (708) 596-5177
- Fax
- (708) 596-5518
- NPI assigned
- Mar 24, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171128003638 | IL | Practitioner - Psychiatry | 3274837075 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1720405129 | IL | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Edgewood Clinical Services, P.C. | Current |
Accepting new patients | |
| Erie Family Health Center, Inc | Current | Accepting new patients | |
| Family Christian Health Center | Current | Accepting new patients |
Locations
1504 S Albany Ave
Chicago, IL 60623
1457 N Halsted St
Unit B303
Chicago, IL 60642
Phone (312) 761-4725
1701 W Superior St
Fl 3
Chicago, IL 60622
Phone (312) 432-7381
1701 W Superior St
Fl 2
Chicago, IL 60622
Phone (323) 361-2122
31 W 155th St
Harvey, IL 60426
Phone (708) 596-5177
19767 Torrence Ave
Lynwood, IL 60411
Phone 7085965177 ext. 8793
Interoperability endpoints
- kbanksword653405@direct.ochin.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 1720405129 | IL | Yes |
Addresses
Primary practice location
31 W 155TH St
Harvey, IL 60426-3556
Mailing address
31 W 155TH St
Harvey, IL 60426-3556
Phone (708) 596-5177
Other practice location 1
5841 S Maryland Ave # Mc3077
Chicago, IL 60637-1447
Phone (773) 834-0373
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 36142489 | Medicaid | IL |
Other providers in Harvey, IL
- Aunt Martha'S Youth Service Center, Inc.
- Aunt Marthas Youth Service Center Inc
- Aunt Marthas Youth Service Center Inc
- Mfombu Ayukesong
- John William Baldwin
- Tiara Banks
- Laverne Monise Barnes
- Cynthia Baron
- Judith M Bazil
- Charles A Beck Jr.
All providers in Harvey, IL · Psychiatry Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 10, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.