Individual provider Active NPI

Victoria Bernard

  • Psychologist
  • Chicago, IL
National Provider Identifier
1790263192
Registry record updated Nov 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
071011001 Issued in IL
Practice address
150 E Huron St Ste 1100
Chicago, IL 60611-2948
Phone
(312) 926-3627
Fax
(312) 926-6285
NPI assigned
Jul 30, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Psychologist 103T00000X 071011001 IL Primary
Clinical Psychologist 103TC0700X PSY.0005436 CO

Addresses

Primary practice location

150 E Huron St Ste 1100
Chicago, IL 60611-2948

Mailing address

1870 W 122ND Ave
Westminster, CO 80234-2024
Phone (303) 853-3500

Other practice location 1

8931 Huron St
Thornton, CO 80260-6806
Phone (303) 853-3500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20210205000285 CO Practitioner - Clinical Psychologist 4385058189 Reassigns benefits to 1 organization
I20231205003432 IL Practitioner - Clinical Psychologist 4385058189 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Northwestern Medical Faculty FoundationGroup PAC ID 4587576814, 4,386 clinicians

Practice addresses (Care Compare)

150 E Huron St
Suite 1100
Chicago, IL 60611-2948
Phone (312) 926-3627

675 N Saint Clair St
Chicago, IL 60611-5975

675 N St Clair
Chicago, IL 60611-5975

Merit-based Incentive Payment System (MIPS)

Final score
95.19 of 100Reported as apm
Quality
83.05
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
071011001ILMDPsychologist
PSY.0005436COMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince Oct 28, 2023 Accepting new patients
Sondermind Provider Network LLC Clinical CurrentSince Jun 15, 2022 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Oct 28, 2023 Accepting new patients

Locations

720 S Colorado Blvd
Ph N
Glendale, CO 80246
Phone (833) 988-0589

Dept 5777
Carol Stream, IL 60122

150 E Huron St
Ste 1100
Chicago, IL 60611
Phone (312) 926-9355

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

Organizations & group practices 3

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": "1532908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700611200000",
    "number": "1790263192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1870 W 122ND AVE",
            "city": "WESTMINSTER",
            "state": "CO",
            "postal_code": "802342024",
            "telephone_number": "303-853-3500",
            "fax_number": "303-853-3702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 E HURON ST STE 1100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112948",
            "telephone_number": "312-926-3627",
            "fax_number": "312-926-6285"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8931 Huron St",
            "address_purpose": "LOCATION",
            "city": "Thornton",
            "state": "CO",
            "postal_code": "802606806",
            "country_code": "US",
            "telephone_number": "303-853-3500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BERNARD",
        "first_name": "VICTORIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-30",
        "last_updated": "2023-11-22",
        "certification_date": "2023-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IL",
            "license": "071011001",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CO",
            "license": "PSY.0005436",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.