Individual provider Active NPI

Laura Benedict Pettineo, PHD

  • Clinical Psychologist
  • Glenview, IL
National Provider Identifier
1912319484
Registry record updated Apr 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071009478 Issued in IL
Practice address
2180 Pfingsten Rd Ste 2000
Glenview, IL 60026-1339
Phone
(847) 425-6400
NPI assigned
Jun 2, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 7, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 071009478 IL Primary

Addresses

Primary practice location

2180 Pfingsten Rd Ste 2000
Glenview, IL 60026-1339

Mailing address

2180 Pfingsten Rd Ste 2000
Glenview, IL 60026-1339
Phone (847) 425-6400

Other names 1

  • Laura Jeanne Benedict Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lpettineo264523@direct.northshore.org

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
I20170524001798 IL Practitioner - Clinical Psychologist 8921375809 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Endeavor Health Medical GroupGroup PAC ID 2163334699, 3,330 clinicians

Practice addresses (Care Compare)

2100 Pfingsten Rd
Glenview, IL 60026-1301

2650 Ridge Ave
Evanston, IL 60201-1700

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.9 of 100Reported as group
Quality
75.91
Promoting interoperability
99
Improvement activities
40
Cost
74.6

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Endeavor Health Medical Group CurrentSince May 30, 2017 Accepting new patients
Endeavor Health Medical Group CurrentSince May 30, 2017 Accepting new patients

Locations

9532 Eagle Way
Chicago, IL 60678

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206

2650 Ridge Ave
Ste 1223
Evanston, IL 60201
Phone (847) 982-3175

2180 Pfingsten Rd
Ste 2000
Glenview, IL 60026

Interoperability endpoints

  • Direct secure messaging: lpettineo264523@direct.northshore.org

Organizations & group practices 2

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 1

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

NPI Registry JSON

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

{
    "created_epoch": "1401667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617753600000",
    "number": "1912319484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2180 PFINGSTEN RD STE 2000",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600261339",
            "telephone_number": "847-425-6400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2180 PFINGSTEN RD STE 2000",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600261339",
            "telephone_number": "847-425-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTINEO",
        "first_name": "LAURA",
        "middle_name": "BENEDICT",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-06-02",
        "last_updated": "2021-04-07",
        "certification_date": "2021-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071009478",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lpettineo264523@direct.northshore.org",
            "affiliation": "N",
            "address_1": "2180 Pfingsten Rd Ste 2000",
            "city": "Glenview",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600261339",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "LAURA",
            "last_name": "BENEDICT",
            "middle_name": "JEANNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Glenview, IL

Sources for this page

Verify at the official NPI Registry.