NPIMap

Organization Active NPI

Keith V Bjorge PSYD PC

Doing business as Crossroads

  • Clinical Psychologist
  • Lake Zurich, IL
National Provider Identifier
1790854636
Registry record updated Nov 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071005483 Issued in IL
Legal business name
KEITH V BJORGE PSYD PC
Doing business as
Crossroads
Practice address
61 S Old Rand Rd
Lake Zurich, IL 60047-3127
Phone
(815) 578-4222
Fax
(847) 438-0844
NPI assigned
Nov 7, 2006
Last updated
Nov 10, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2011

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

Authorized official

Name
Dr. Keith V Bjorge, PSYDNPI 1700053360
Title
President/Psychologist
Phone
(815) 578-4222

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 2091057 WI
Clinical Psychologist 103TC0700X 071005483 IL Primary

Addresses

Primary practice location

61 S Old Rand Rd
Lake Zurich, IL 60047-3127

Mailing address

61 S Old Rand Rd
Lake Zurich, IL 60047-3127
Phone (815) 578-4222

Other names 1

  • Crossroads Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320883200000",
    "number": "1790854636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "61 S OLD RAND RD",
            "city": "LAKE ZURICH",
            "state": "IL",
            "postal_code": "600473127",
            "telephone_number": "815-578-4222",
            "fax_number": "847-438-0844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "61 S OLD RAND RD",
            "city": "LAKE ZURICH",
            "state": "IL",
            "postal_code": "600473127",
            "telephone_number": "815-578-4222",
            "fax_number": "847-438-0844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEITH V BJORGE PSYD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2011-11-10",
        "status": "A",
        "authorized_official_last_name": "BJORGE",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "PRESIDENT/PSYCHOLOGIST",
        "authorized_official_telephone_number": "815-578-4222",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WI",
            "license": "2091057",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071005483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crossroads",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Zurich, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.