Jeffrey T Feathergill, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

20041616A Issued in IN

Practice address

211 W Washington St Ste 2311
South Bend, IN 46601-1708

Phone

(574) 282-1090

Fax

(866) 540-3094

NPI assigned

Jun 28, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2012 through Jan 1, 2028

Medicare enrollment (NPD)

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.

• Feathergill & Associates LLC

  • Clinical Psychologist
  • Mishawaka, IN
  • NPI 1821369836

  Addiction (Substance Use Disorder)

  NPD (past) Authorized official
• Psychology Associates, P.C.

  • Clinical Neuropsychologist
  • Mishawaka, IN
  • NPI 1639285232

  Psychologist

  NPD (past)
• Endeavor Health Medical Group

  • Anesthesiology Physician
  • Evanston, IL
  • NPI 1265695944
  NPD (past)
• Endeavor Health Medical Group

  • Emergency Medicine Physician
  • Evanston, IL
  • NPI 1497701882
  NPD (past)

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327276800000",
    "number": "1982632329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 W WASHINGTON ST STE 2311",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011708",
            "telephone_number": "574-282-1090",
            "fax_number": "866-540-3094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 W WASHINGTON ST STE 2311",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011708",
            "telephone_number": "574-282-1090",
            "fax_number": "866-540-3094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEATHERGILL",
        "first_name": "JEFFREY",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2012-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "IN",
            "license": "20041616A",
            "primary": false
        },
        {
            "code": "103TA0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Adult Development & Aging",
            "state": "IN",
            "license": "20041616A",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20041616A",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IN",
            "license": "20041616A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela Marie Faulkner, FNP
• Christina B. Faulkner, MA-CCC-SLP
• Brian Andrew Faust, O.D.
• Shalom Fausto Espiricueta
• Morgan Lynn Fean
• Billie Rae Federspiel, NP
• Thomas Allen Felger, M.D.
• Daysha Bliss Feliciano
• Payton Fell
• Molly Lynn Feller

• All providers in South Bend, IN
• Clinical Psychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.