NPIMap

Organization Active NPI

Fort Health Medical Group PA

Doing business as Fort Health Medical Group of IL

  • Child & Adolescent Psychiatry Physician
  • Springfield, IL
National Provider Identifier
1972342046
Registry record updated Mar 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
Legal business name
FORT HEALTH MEDICAL GROUP PA
Doing business as
Fort Health Medical Group of IL
Practice address
600 S 2ND St Ste 404
Springfield, IL 62704-2542
Phone
(201) 208-2616
Fax
(973) 381-5773
NPI assigned
May 20, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2025

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

Authorized official

Name
Traci Crosby
Title
Credentialing Manager
Phone
(201) 503-4815

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Clinical Child & Adolescent PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC2200X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Child & Adolescent Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0804X Primary
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

600 S 2ND St Ste 404
Springfield, IL 62704-2542

Mailing address

613 Washington Blvd # 1297
Jersey City, NJ 07310-2900
Phone (201) 208-2616

Other names 1

  • Fort Health Medical Group of IL Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Fort Health Medical Group5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1716163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742947200000",
    "number": "1972342046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "613 WASHINGTON BLVD # 1297",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073102900",
            "telephone_number": "201-208-2616",
            "fax_number": "973-381-5773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 S 2ND ST STE 404",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627042542",
            "telephone_number": "201-208-2616",
            "fax_number": "973-381-5773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT HEALTH MEDICAL GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-20",
        "last_updated": "2025-03-26",
        "certification_date": "2025-03-26",
        "status": "A",
        "authorized_official_last_name": "CROSBY",
        "authorized_official_first_name": "TRACI",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "201-503-4815"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fort Health Medical Group of IL",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fort Health Medical Group of IL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Springfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2025; 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.