Mindful Psychiatric Services, MDSC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

MINDFUL PSYCHIATRIC SERVICES, MDSC

Practice address

1802 N Division St Ste 509
Morris, IL 60450-3107

Phone

(815) 941-3882

Fax

(815) 941-3884

NPI assigned

Aug 28, 2020

Organization subpart

No

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

Authorized official

Name

Dr. James Dyers, DONPI 1861679888

Title

President

Phone

(815) 941-3882

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• James Vincent Dyers Jr., D.O.

  • Psychiatry Physician
  • Morris, IL
  • NPI 1861679888
  Medicare reassignment Care Compare group NPD Authorized official
• Victoria Brueggert

  • Nurse Practitioner
  • Galena, IL
  • NPI 1992231260
  Medicare reassignment Care Compare group NPD
• Beth Gomez, FNP BC PMHNP BC

  • Family Nurse Practitioner
  • Onarga, IL
  • NPI 1609263417

  Psychiatric/Mental Health

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1598572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598572800000",
    "number": "1801409974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1802 N DIVISION ST STE 509",
            "city": "MORRIS",
            "state": "IL",
            "postal_code": "604503107",
            "telephone_number": "815-941-3882",
            "fax_number": "815-941-3884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1802 N DIVISION ST STE 509",
            "city": "MORRIS",
            "state": "IL",
            "postal_code": "604503107",
            "telephone_number": "815-941-3882",
            "fax_number": "815-941-3884"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13550 S Route 30 Ste 302",
            "address_purpose": "LOCATION",
            "city": "Plainfield",
            "state": "IL",
            "postal_code": "605445688",
            "country_code": "US",
            "telephone_number": "815-941-3882",
            "fax_number": "815-941-3884",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MINDFUL PSYCHIATRIC SERVICES, MDSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-28",
        "last_updated": "2020-08-28",
        "certification_date": "2020-08-26",
        "status": "A",
        "authorized_official_last_name": "DYERS",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-941-3882",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary N Menz, DO
• Raymond J Meyer, M.D.
• Stephanie Louise Mickley, FNP-C
• Heidi Kristina Miller, APN
• Mind Over Matter Psychotherapy P.C.
• Michelle Lee Mitchell, N.C.
• Hatimali Imtiaz Husain Mithaiwala, DDS
• Reena Raman Modjeski, DMD
• Morris Audiology Inc.
• Morris Comm HS Dist 101

• Psychiatry Physician in Morris, IL
• Providers in Morris, IL by specialty
• Psychiatry Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.