Active NPI
Ryan Dieschbourg
- Counselor
- La Grange Park, IL
National Provider Identifier
1962879825
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- D21672589325
- Practice address
- 333 N la Grange Rd
La Grange Park, IL 60526-5646 - Phone
- (708) 745-5277
- NPI assigned
- Aug 26, 2015
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | D21672589325 | IL | Primary |
Addresses
Primary practice location
333 N la Grange Rd
La Grange Park, IL 60526-5646
Mailing address
11243 E Chesapeake PL
Westchester, IL 60154-5928
Phone (708) 369-3935
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| XOF890603919 | Other | IL | BLUE CROSS BLUESHIELD |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D21672589325 | IL | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1440547200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1440547200000",
"number": "1962879825",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11243 E CHESAPEAKE PL",
"city": "WESTCHESTER",
"state": "IL",
"postal_code": "601545928",
"telephone_number": "708-369-3935"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "333 N LA GRANGE RD",
"city": "LA GRANGE PARK",
"state": "IL",
"postal_code": "605265646",
"telephone_number": "708-745-5277"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIESCHBOURG",
"first_name": "RYAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-08-26",
"last_updated": "2015-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "IL",
"license": "D21672589325",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUESHIELD",
"identifier": "XOF890603919",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in La Grange Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.