TRISTATE WELLNESS MGT LLC
NPI 1609821164
Psychologist - Clinical in Chicago, IL

NPI Status: Active since May 23, 2006

Contact Information

2826 N TALMAN
UNIT J
CHICAGO, IL
ZIP 60618
Phone: (708) 646-5738
Fax: (866) 587-1485

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  • Organization
  • Psychologist
  • Clinical

About TRISTATE WELLNESS MGT LLC

This page provides the complete NPI Profile along with additional information for Tristate Wellness Mgt Llc, a provider established in Chicago, Illinois operating as a Psychologist, focusing in clinical . The healthcare provider is registered in the NPI registry with number 1609821164 assigned on May 2006. The practitioner's primary taxonomy code is 103TC0700X with license number 036093462 (IL). The provider is registered as an organization and their NPI record was last updated 18 years ago. Tristate Wellness Mgt Llc operates as a multi-specialty business group with one or more individual providers who practice different areas of specialization. The authorized official of this NPI record is Philip Douglas Thompson (Program Director)

NPI
1609821164
Provider Name
TRISTATE WELLNESS MGT LLC
Entity Type
Organization
Location Address
2826 N TALMAN UNIT J CHICAGO, IL 60618
Location Phone
(708) 646-5738
Location Fax
(866) 587-1485
Mailing Address
2826 N TALMAN UNIT J CHICAGO, IL 60618
Mailing Phone
(708) 646-5738
Mailing Fax
(866) 587-1485
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
05-23-2006
Last Update Date
01-08-2008
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A clinical psychologist like Tristate Wellness Mgt Llc assesses, diagnoses, and treats mental, emotional, and behavioral disorders. Clinical psychologists help people deal with problems ranging from short-term personal issues to severe, chronic conditions. Clinical psychologists interview patients, give diagnostic tests, provide psychotherapy and design behavior modification programs to help patients.

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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Psychologist Clinical

Taxonomy Code
103TC0700X
Type
Behavioral Health & Social Service Providers
License No.
036093462
License State
IL
Taxonomy Description
A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

Secondary Taxonomies

The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.

No. Taxonomy Code Type Classification /
Specialization
License No. (State)
1103TC0700XBehavioral Health & Social Service Providers

Psychologist
Clinical

336-008797 (IL)

Group Taxonomy 193200000X MULTI-SPECIALTY GROUP

This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

PHILIP DOUGLAS THOMPSON

Authorized Official Title
PROGRAM DIRECTOR
Authorized Official Phone
(708) 646-5738

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State Identifier Issuer
036039387MEDICAID (05)IL 
213378MEDICARE UPIN (02) 
431830MEDICARE PIN (08)IL 
E572246MEDICARE UPIN (02)IL 
H46124MEDICARE UPIN (02)IL 
K26727MEDICARE ID-TYPE UNSPECIFIED (04)ILDR. BENJAMIN MARGOLIS
213378MEDICARE ID-TYPE UNSPECIFIED (04)ILGROUP MEDICARE NUMBER
K17910MEDICARE ID-TYPE UNSPECIFIED (04)ILDR. WALTER WROBEL
036093462MEDICAID (05)IL 

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NPI Validation Check Digit Calculation


The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1609821164
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
26091622112
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 6 + 0 + 9 + 1 + 6 + 2 + 2 + 1 + 1 + 2 + 24 = 56
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
60 - 56 = 44

The NPI number 1609821164 is valid because the calculated check digit 4 using the Luhn validation algorithm matches the last digit of the original NPI number.

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1609821164, enumerated in the NPI registry as an "organization" on May 23, 2006

The provider is located at 2826 N Talman Unit J Chicago, Il 60618 and the phone number is (708) 646-5738

This medical organization specializes in Psychologist with taxonomy code 103TC0700X with a focus in Clinical

The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.

This NPI record was last updated on May 23, 2006. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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