Individual provider Active NPI

Christina Boisseau, PHD

  • Clinical Psychologist
  • Chicago, IL
National Provider Identifier
1760806012
Registry record updated Feb 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071009835 Issued in IL
Practice address
446 E Ontario St Ste 7-100
Chicago, IL 60611-4418
Phone
(312) 695-5060
Fax
(312) 695-5060
NPI assigned
Feb 6, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PS01348 RI
Clinical Psychologist 103TC0700X 071009835 IL Primary

Addresses

Primary practice location

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

Mailing address

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

Other practice location 1

676 N Saint Clair St Ste 1000
Chicago, IL 60611-2976
Phone (312) 695-8441

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
I20180906000638 IL Practitioner - Clinical Psychologist 5395068050 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Boston University School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

675 N Saint Clair St
Chicago, IL 60611-5975

675 N St Clair
Chicago, IL 60611-5975

676 N Saint Clair
Chicago, IL 60611-2927

676 N Saint Clair St
Chicago, IL 60611-2927

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
071009835ILMDClinical Psychologist

Practice roles

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

Locations

Dept 5777
Carol Stream, IL 60122

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

676 N Saint Clair St
Ste 1000
Chicago, IL 60611
Phone (855) 695-8441

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

446 E Ontario St
#7100
Chicago, IL 60611
Phone (312) 926-5060

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": "1391644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549324800000",
    "number": "1760806012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "446 E ONTARIO ST # 7-100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606114418"
        },
        {
            "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": "312-695-5060"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "676 N Saint Clair St Ste 1000",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606112976",
            "country_code": "US",
            "telephone_number": "312-695-8441",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOISSEAU",
        "first_name": "CHRISTINA",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-02-06",
        "last_updated": "2019-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "RI",
            "license": "PS01348",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071009835",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.