Active NPI
Amberly R. Panepinto, PH.D.
- Clinical Psychologist
- Chicago, IL
National Provider Identifier
1871644385
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- Practice address
- 4653 N Broadway St
Suite 530
Chicago, IL 60640-5011 - Phone
- (312) 310-8560
- NPI assigned
- Jan 13, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | IL | Primary |
Addresses
Primary practice location
4653 N Broadway St
Suite 530
Chicago, IL 60640-5011
Mailing address
2635 N Talman Ave # 3S
Chicago, IL 60647-9409
Phone (312) 310-8560
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01636536 | Other | IL | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200316001331 | NY | Practitioner - Clinical Psychologist | 5092143560 | Practice locations: Orchard Park, NY; Tonawanda, NY |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2004
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
884 Brighton Rd
Tonawanda, NY 14150-8169
Phone (716) 836-9460
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071007069 | IL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168646400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1871644385",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2635 N TALMAN AVE # 3S",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606479409",
"telephone_number": "312-310-8560"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4653 N BROADWAY ST",
"address_2": "SUITE 530",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606405011",
"telephone_number": "312-310-8560"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PANEPINTO",
"first_name": "AMBERLY",
"middle_name": "R.",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "01636536",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.