Individual provider Active NPI

Patricia A Sugrue, NCTMB

  • Professional Counselor
  • Chicago, IL
National Provider Identifier
1841498490
Registry record updated Dec 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
180.014900 Issued in IL
Practice address
3234 W Fullerton Ave
Chicago, IL 60647-2594
Phone
(773) 466-9882
NPI assigned
Jul 5, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 5, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 227.000757 IL
Professional Counselor 101YP2500X 180.014900 IL Primary

Addresses

Primary practice location

3234 W Fullerton Ave
Chicago, IL 60647-2594

Mailing address

1531 W Fargo Ave # 2
Chicago, IL 60626-7079
Phone (773) 989-7562

Other practice location 1

1531 W Fargo Ave # 2
Chicago, IL 60626-7079
Phone (773) 989-7562

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
I20241211001334 IL Practitioner - Mental Health Counselor 4981130143 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
180.014900ILMDProfessional Counselor
227.000757ILMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Five Point Holistic Health Professional CurrentSince Oct 6, 2024 Accepting new patients

Locations

3234 W Fullerton Ave
Chicago, IL 60647
Phone (773) 466-9882

2866 N Milwaukee Ave
Chicago, IL 60618
Phone (773) 466-9882

Organizations & group practices 1

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": "1183593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670198400000",
    "number": "1841498490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1531 W FARGO AVE # 2",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606267079",
            "telephone_number": "773-989-7562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3234 W FULLERTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606472594",
            "telephone_number": "773-466-9882"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1531 W Fargo Ave # 2",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606267079",
            "country_code": "US",
            "telephone_number": "773-989-7562",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SUGRUE",
        "first_name": "PATRICIA",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "NCTMB",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-07-05",
        "last_updated": "2022-12-05",
        "certification_date": "2022-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": "227.000757",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.014900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.