Azadeh Ghaffari, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071008535 Issued in IL

Practice address

2502 N Clark St Ste 206
Chicago, IL 60614-1850

Phone

(773) 850-0294

NPI assigned

Feb 13, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Specialty

Clinical Psychologist

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Chicago Behavioral Clinic LLCGroup PAC ID 6204169253, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Chicago Behavioral Clinic LLC

  • Clinical Psychologist
  • Chicago, IL
  • NPI 1821540428
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1360713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549411200000",
    "number": "1811236755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2502 N CLARK ST STE 206",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606141850",
            "telephone_number": "773-850-0294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2502 N CLARK ST STE 206",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606141850",
            "telephone_number": "773-850-0294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHAFFARI",
        "first_name": "AZADEH",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-13",
        "last_updated": "2019-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TH0004X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health",
            "state": "IL",
            "license": "071008535",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071008535",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI2",
            "identifier": "1821540428",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ghabra & Tarsha Medical Inc
• Saied Ghadersohi, M.D.
• Nafisa Y. Ghadiali
• Quraish Ghadiali, M.D.
• Kamala A Ghaey, MD
• Jacob Sina Ghahremani, MD
• Vivek Ghai, MD
• Ruba Ayman Mahd Ghalayni, M.D.
• Raj B. Ghale
• Miriyam Ghali, MD, MBA

• Clinical Psychologist in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2019; 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.

Verify at the official NPI Registry.