Active NPI
James Kenneth Smedegard, M.D.
- Psychiatry Physician
- Palos Heights, IL
National Provider Identifier
1942393640
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 036071573
- Practice address
- 12255 S 80TH Avenue
Suite 202
Palos Heights, IL 60463 - Phone
- (708) 923-7878
- NPI assigned
- Oct 2, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 036071573 | IL | Primary |
Addresses
Primary practice location
12255 S 80TH Avenue
Suite 202
Palos Heights, IL 60463
Mailing address
12255 S 80TH Avenue
Suite 202
Palos Heights, IL 60463
Phone (708) 923-7878
Other identifiers 11
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7229P | Other | IL | CATERPILLAR |
| 363827229 02 | Other | IL | HERITAGE |
| 219043 | Other | IL | MAGELLAN |
| 363827229 | Other | IL | WPS |
| 363827229 02 | Other | IL | JOHN DEERE |
| L029112 | Other | IL | CHAMPUS |
| 260015287 | Other | IL | RR MEDICARE |
| 0991516762 | Other | IL | BCBS |
| 12368 | Other | IL | JOHN HANCOCK |
| 036071573 | Medicaid | IL | |
| 055429 | Other | IL | VALUE BEHAVIORAL HEALTH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036071573 | IL | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1942393640",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12255 S 80TH AVENUE",
"address_2": "SUITE 202",
"city": "PALOS HEIGHTS",
"state": "IL",
"postal_code": "60463",
"telephone_number": "708-923-7878"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12255 S 80TH AVENUE",
"address_2": "SUITE 202",
"city": "PALOS HEIGHTS",
"state": "IL",
"postal_code": "60463",
"telephone_number": "708-923-7878"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMEDEGARD",
"first_name": "JAMES",
"middle_name": "KENNETH",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "IL",
"license": "036071573",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CATERPILLAR",
"identifier": "7229P",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HERITAGE",
"identifier": "363827229 02",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN",
"identifier": "219043",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WPS",
"identifier": "363827229",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "JOHN DEERE",
"identifier": "363827229 02",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHAMPUS",
"identifier": "L029112",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "260015287",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "0991516762",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "JOHN HANCOCK",
"identifier": "12368",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036071573",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE BEHAVIORAL HEALTH",
"identifier": "055429",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Palos Heights, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.