Thomas Smith Sr.

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

1093075301 Issued in IL

Practice address

369 E Sibley Blvd
Harvey, IL 60426-2530

Phone

(888) 205-5532

NPI assigned

Apr 6, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Psycynergy Psychological Services PC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Harvey, IL
  • NPI 1093075301
  NPD (past)

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

{
    "created_epoch": "1491436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540944000000",
    "number": "1972036994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "369 E SIBLEY BLVD STE A",
            "city": "HARVEY",
            "state": "IL",
            "postal_code": "604262535",
            "telephone_number": "888-205-5532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "369 E SIBLEY BLVD",
            "city": "HARVEY",
            "state": "IL",
            "postal_code": "604262530",
            "telephone_number": "888-205-5532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "THOMAS",
        "name_suffix": "Sr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-06",
        "last_updated": "2018-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "IL",
            "license": "1093075301",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1093075301",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sheth Sushil a MD SC
• Sushil A Sheth, MD
• Robert Singh, MD
• Trina Sircar, DO
• Diane Smith, NP
• Enric P. Solans, M.D.
• South Shore Behavioral Consultants
• Southwest Laboratory Physicians, S.C.
• Karen Sperti
• Stairway to Greatness Mentorship-Entrepreneurship Program

• Behavior Technician in Harvey, IL
• Providers in Harvey, IL by specialty
• Behavior Technician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.