Edward J Klutcharch, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071008553 Issued in IL

Practice address

6502 Joliet Rd
Countryside, IL 60525-4682

Phone

(708) 608-1167

NPI assigned

Mar 19, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Group practices

Oak Forest Psychological ServiceGroup PAC ID 6507762580, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Oak Forest Psychological Service

  • Clinical Psychologist
  • Countryside, IL
  • NPI 1225209414
  Medicare reassignment Care Compare group NPD
• Oak Forest Psychological Service

  • Clinical Psychologist
  • Countryside, IL
  • NPI 1265487060
  Medicare reassignment
• Oak Forest Psychological Service

  • Clinical Psychologist
  • Countryside, IL
  • NPI 1326219510
  NPD

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

{
    "created_epoch": "1363651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658188800000",
    "number": "1861734600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8624 WHEELER DR",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604624704",
            "telephone_number": "708-608-1167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6502 JOLIET RD",
            "city": "COUNTRYSIDE",
            "state": "IL",
            "postal_code": "605254682",
            "telephone_number": "708-608-1167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLUTCHARCH",
        "first_name": "EDWARD",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-03-19",
        "last_updated": "2022-07-19",
        "certification_date": "2022-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071008553",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Athanasia Katsigiannis, LPC
• Christina Kelly
• Paige Kessler
• Shannon King
• Rebecca Lynn Kinst, LPC, NCC
• Richard Alan Kohn, DDS MS
• Marie Ann Korallus, RN, MSN, APRN,FNP-C
• Ashok Kothari, DDS, MDS
• Kryken International Inc
• Abigail Charlotte Lafont

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2022; 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.