Active NPI
Mikell Ryanne Ehnle, PSYD
- Psychologist
- Peoria, IL
National Provider Identifier
1780973925
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 071.008074
- Practice address
- 3716 W Brighton Ave
Peoria, IL 61615-2938 - Phone
- (309) 692-7755
- NPI assigned
- Mar 28, 2011
- Last updated
- Sep 24, 2018
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 071.008074 | IL | Primary |
Addresses
Primary practice location
3716 W Brighton Ave
Peoria, IL 61615-2938
Mailing address
2300 S Main St
Apt C
Eureka, IL 61530-1633
Phone (847) 848-0203
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
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
3716 W Brighton Ave
Peoria, IL 61615-2938
Phone (309) 692-7755
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071.008074 | IL | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| John Day & Associates, LTD | Current | Accepting new patients |
Locations
102 N Main St
Bloomington, IL 61701
3716 W Brighton Ave
Peoria, IL 61615
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.
-
- Clinical Psychologist
- Peoria, IL
- NPI 1245454313
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1301270400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1537747200000",
"number": "1780973925",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2300 S MAIN ST",
"address_2": "APT C",
"city": "EUREKA",
"state": "IL",
"postal_code": "615301633",
"telephone_number": "847-848-0203"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3716 W BRIGHTON AVE",
"city": "PEORIA",
"state": "IL",
"postal_code": "616152938",
"telephone_number": "309-692-7755"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EHNLE",
"first_name": "MIKELL",
"middle_name": "RYANNE",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-03-28",
"last_updated": "2018-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "IL",
"license": "071.008074",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2018; 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.