Active NPI
Tracy Aneziris, PSY.D.
- Clinical Psychologist
- Schaumburg, IL
National Provider Identifier
1912518143
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071010329
- Practice address
- 455 S Roselle Rd
Schaumburg, IL 60193-2971 - Phone
- (847) 730-9394
- NPI assigned
- Aug 12, 2020
- Last updated
- Aug 12, 2020
- Sex
- Female
- Sole proprietor
- No
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 | 071010329 | IL | Primary |
Addresses
Primary practice location
455 S Roselle Rd
Schaumburg, IL 60193-2971
Mailing address
312 Natwick LN
Schaumburg, IL 60193-1044
Phone (847) 730-9394
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200827000809 | IL | Practitioner - Clinical Psychologist | 7618394289 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071010329 | IL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597190400000",
"number": "1912518143",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "312 NATWICK LN",
"city": "SCHAUMBURG",
"state": "IL",
"postal_code": "601931044",
"telephone_number": "847-730-9394"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "455 S ROSELLE RD",
"city": "SCHAUMBURG",
"state": "IL",
"postal_code": "601932971",
"telephone_number": "847-730-9394"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANEZIRIS",
"first_name": "TRACY",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-08-12",
"last_updated": "2020-08-12",
"certification_date": "2020-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071010329",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Schaumburg, IL
- Andersontiernan, Inc (Advanced Foot & Ankle Centers of Illinois)
- Marija Andreevski
- Katerina Sophia Andrews
- Athanasios S Andriopoulos, PHARM.D.
- Andrzej Sowinski Medical Offices SC
- Angelfish Enterprises, Inc (FirstLight Home Care)
- Ann & Robert H Lurie Childrens Hospital of Chicago (Lurie Children's Specialty Pharmacy)
- Ann & Robert H Lurie Childrens Hospital of Chicago (Lurie Children's Specialty Pharmacy)
- Mohammed Sajid Hussain Ansari, MD
- Jamie Anticevich, PA-C
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2020; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.