Icon Psychologies Corp

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

ICON PSYCHOLOGIES CORP

Practice address

620 N River Rd Ste 106
Naperville, IL 60563-8951

Phone

(630) 364-2484

Fax

(630) 536-8511

NPI assigned

Apr 22, 2015

Last updated

Nov 26, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Soberekon M Koko, MDNPI 1992918866

Title

Owner/Medical Director

Phone

(312) 342-6066

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Soberekon Melvin Koko, M.D.

  • Neurology Physician
  • Chicago, IL
  • NPI 1992918866
  Medicare reassignment Authorized official
• Taryrsha Davis, APN

  • Nurse Practitioner
  • Hazel Crest, IL
  • NPI 1821552761
  Medicare reassignment

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

{
    "created_epoch": "1429660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1511654400000",
    "number": "1972990497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 N RIVER RD STE 106",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605638951",
            "telephone_number": "630-364-2484",
            "fax_number": "630-536-8511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 N RIVER RD STE 106",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605638951",
            "telephone_number": "630-364-2484",
            "fax_number": "630-536-8511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICON PSYCHOLOGIES CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-22",
        "last_updated": "2017-11-26",
        "status": "A",
        "authorized_official_last_name": "KOKO",
        "authorized_official_first_name": "SOBEREKON",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "312-342-6066",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatry Physician in Naperville, IL
• Providers in Naperville, IL by specialty
• Psychiatry Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2017; 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.