NPIMap

Organization Active NPI

Gregory Malo PSYD & Associates in Neuropsychology PC

  • Adult Mental Health Clinic/Center
  • Lombard, IL
National Provider Identifier
1932264207
Registry record updated Dec 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
License
071002647 Issued in IL
Legal business name
GREGORY MALO PSYD & ASSOCIATES IN NEUROPSYCHOLOGY PC
Practice address
477 E Butterfield Rd Ste 102
Lombard, IL 60148-4880
Phone
(630) 424-8900
Fax
(630) 424-9017
NPI assigned
Dec 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2022

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

Authorized official

Name
Randall Warren SummervilleNPI 1821180803
Title
Owner
Phone
(630) 424-8900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical NeuropsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103G00000X
Adult Mental Health Clinic/Center 261QM0850X 071002647 IL Primary

Addresses

Primary practice location

477 E Butterfield Rd Ste 102
Lombard, IL 60148-4880

Mailing address

477 E Butterfield Rd Ste 102
Lombard, IL 60148-4880
Phone (630) 424-8900

Other names 1

  • ARCC Neuropsychology Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070425000582 IL Part B Supplier - Clinic/Group Practice 5799881488 Receives reassigned benefits from 4 practitioners
Practice locations: Lombard, IL

National Provider Directory

National Provider Directory

Locations

2835 N Sheffield Ave
Ste 214
Chicago, IL 60657
Phone (630) 424-8900

246 E Janata Blvd
Ste 112
Lombard, IL 60148
Phone (630) 424-8900

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1167091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670198400000",
    "number": "1932264207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "477 E BUTTERFIELD RD STE 102",
            "city": "LOMBARD",
            "state": "IL",
            "postal_code": "601484880",
            "telephone_number": "630-424-8900",
            "fax_number": "630-424-9017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "477 E BUTTERFIELD RD STE 102",
            "city": "LOMBARD",
            "state": "IL",
            "postal_code": "601484880",
            "telephone_number": "630-424-8900",
            "fax_number": "630-424-9017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREGORY MALO PSYD & ASSOCIATES IN NEUROPSYCHOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-26",
        "last_updated": "2022-12-05",
        "certification_date": "2022-12-05",
        "status": "A",
        "authorized_official_last_name": "SUMMERVILLE",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "WARREN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "630-424-8900"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "IL",
            "license": "071002647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ARCC Neuropsychology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lombard, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.