Individual provider Active NPI

Tyler Inghram

  • Mental Health Counselor
  • Dixon, IL
National Provider Identifier
1811500390
Registry record updated Aug 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
325 Illinois RT 2
Dixon, IL 61021-9118
Phone
(815) 284-6611
NPI assigned
Aug 25, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

325 Illinois RT 2
Dixon, IL 61021-9118

Mailing address

69 Plummer Ave
Chadwick, IL 61014-9366

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240112001610 IL Practitioner - Mental Health Counselor 6608226212 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sinnissippi Centers IncGroup PAC ID 3476459876, 32 clinicians

Practice addresses (Care Compare)

325 Il Route 2
Dixon, IL 61021-9118
Phone 81528466118220

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Sinnissippi Centers, Inc. CurrentSince Jan 1, 2024 Accepting new patients
Sinnissippi Centers, Inc. Current Accepting new patients
Sinnissippi Centers, Inc. CurrentSince Jan 1, 2024 Accepting new patients

Locations

Rte 2 325 Illinois
Dixon, IL 61021

325 Il Route 2
Dixon, IL 61021
Phone (815) 288-6611

325 Illinois Route 2
Dixon, IL 61021
Phone (815) 562-3801

1321 N 7th St
Rochelle, IL 61068
Phone (815) 562-3801

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": "1598313600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598313600000",
    "number": "1811500390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "69 PLUMMER AVE",
            "city": "CHADWICK",
            "state": "IL",
            "postal_code": "610149366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 ILLINOIS RT 2",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "610219118",
            "telephone_number": "815-284-6611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INGHRAM",
        "first_name": "TYLER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-25",
        "last_updated": "2020-08-25",
        "certification_date": "2020-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dixon, IL

Sources for this page

Verify at the official NPI Registry.