Individual provider Active NPI

Angela Jean Potaczek

  • Professional Counselor
  • Oak Park, IL
National Provider Identifier
1891847588
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Practice address
120 S Marion St
Oak Park, IL 60302-2809
Phone
(708) 383-7500
Fax
(708) 383-7780
NPI assigned
Jan 16, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X IL Primary

Addresses

Primary practice location

120 S Marion St
Oak Park, IL 60302-2809

Mailing address

1745 N Natoma Ave
Chicago, IL 60707-3917

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
I20240508003108 IL Practitioner - Mental Health Counselor 5193175933 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Thrive Counseling CenterGroup PAC ID 7810809019, 11 clinicians

Practice addresses (Care Compare)

120 S Marion St
Oak Park, IL 60302-2809
Phone (708) 383-7500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
180003749ILMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Thrive Counseling Center CurrentSince Mar 26, 2024 Accepting new patients

Locations

120 S Marion St
Oak Park, IL 60302
Phone (708) 383-7500

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/thrivecc/r4/

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1891847588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1745 N NATOMA AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "607073917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 S MARION ST",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603022809",
            "telephone_number": "708-383-7500",
            "fax_number": "708-383-7780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTACZEK",
        "first_name": "ANGELA",
        "middle_name": "JEAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Park, IL

Sources for this page

Verify at the official NPI Registry.