NPIMap

Individual provider Active NPI

Bethany A Rosner

  • Clinical Psychologist
  • Chicago, IL
National Provider Identifier
1891350625
Registry record updated Nov 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071-010941 Issued in IL
Practice address
2608 N Washtenaw Ave
Chicago, IL 60647-5715
Phone
(815) 322-6715
NPI assigned
May 7, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 5, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X
Clinical Psychologist 103TC0700X 071-010941 IL Primary

Addresses

Primary practice location

2608 N Washtenaw Ave
Chicago, IL 60647-5715

Mailing address

2608 N Washtenaw Ave
Chicago, IL 60647-5715
Phone (815) 322-6715

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address brosner@ego.thechicagoschool.edu Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230421000717 IL Practitioner - Clinical Psychologist 2264897446 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cook CountyGroup PAC ID 2860398088, 770 clinicians

Practice addresses (Care Compare)

1901 W Harrison St
Chicago, IL 60612-3714
Phone (312) 633-7292

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
071-010941ILMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Cook County CurrentSince Oct 25, 2024 Accepting new patients
Cook County CurrentSince Oct 25, 2024 Accepting new patients
Cook County Current Accepting new patients
Pcpa Legacy, LLC Clinical PastSince Feb 1, 2023 Accepting new patients

Locations

1901 W Harrison St
Chicago, IL 60612
Phone (312) 864-5100

1900 W Polk St
Ste 220C
Chicago, IL 60612

500 E 51st St
Chicago, IL 60615
Phone (312) 572-2000

Organizations & group practices 4

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.

Hospital & facility affiliations 27

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1557187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730764800000",
    "number": "1891350625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2608 N WASHTENAW AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606475715",
            "telephone_number": "815-322-6715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2608 N WASHTENAW AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606475715",
            "telephone_number": "815-322-6715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSNER",
        "first_name": "BETHANY",
        "middle_name": "A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-05-07",
        "last_updated": "2024-11-05",
        "certification_date": "2024-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071-010941",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "brosner@ego.thechicagoschool.edu",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Chicago",
            "address_1": "2608 N Washtenaw Ave",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606475715",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.