Unknown Individual – Psychiatry Physician, NPI 1205932241

Psychiatry Physician

Unknown Individual is a healthcare provider. based in Oakbrook terrace, Illinois. specializing in Psychiatry Physician. They hold a License No. 036089586 (IL). The NPI Number for Unknown Individual is 1205932241

Main info

Organization

Inactive

30 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1205932241

Phone

(630) 424-9204

Address

18W100 22ND ST

Deactivation Date

5 July 2023

Doctor Profile

Medical School Name

UNIVERSITY OF ILLINOIS COLLEGE OF MED (CHI/PEOR/ROCK/CHM-URB)

Secondary Phone

6184365665

Graduation Year

1996 (30 years ago)

PAC ID

7012914146

Group Practice PAC ID

9234022567

Professional Enrollment ID

I20061101000574

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience14

Completeness75

Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

18W100 22ND ST
SUITE 130
OAKBROOK TERRACE, IL 601814499
Phone: (630) 424-9204
Type: Location
Wilson Show Stable, 387, Shannon Drive Northeast, Addison Heights, Marietta, Cobb, Georgia, 30066-3861, United States
ADDISON, IL 601010387
Phone: (630) 424-9204
Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

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Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

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Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 60181)

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Provider's Procedures

Unknown Individual performs procedures in Psychiatry Physician. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
PSYCHIATRY	IL	90792	Psychiatric diagnostic evaluation with medical services	21	21

Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 9234022567View full group profile

Name	Specialty	State
ROBERT CUFF (MD)	Vascular Surgery	IL
HONG CHEN (MD)	P A T H O L O G Y	IL
ROBERT KEVIN JR. SCHERGEN (DPM)	P O D I A T R Y	MO
MELANIE CROSS (FNP)	Nurse Practitioner	MO
MRS. ERICA LYNNE IBENDAHL (M.D.)	General Surgery	MO
MRS. AMBER LYNN WENNERSTROM (DNP, PMHNP-C)	Nurse Practitioner	IL
JENNIFER LYNN STARR (FNP-C)	Nurse Practitioner	IL
KERRY LYNN PITCHFORD (APRN, FNP-BC)	Nurse Practitioner	IL
KARLA WEBB (APN)	Nurse Practitioner	IL
Unknown Individual	-	IL