DR. JERRY MARK OTOOLE (PSYD) – Psychologist, NPI 1790393650

DR. JERRY MARK OTOOLE (PSYD) is a healthcare provider. based in Plainfield, Illinois. specializing in CLINICAL PSYCHOLOGIST. They hold the professional credentials PSYD. They hold a License No. 071006413 (IL). The NPI Number for DR. JERRY MARK OTOOLE (PSYD) is 1790393650

Main info

Male
Sole Proprietor
26 Years Of Experience
Accepts Medicare Assignment
Name
DR. JERRY MARK OTOOLE (PSYD)
NPI
1790393650
Phone
(240) 449-5170
Address
12816 TIMBER WOOD CIR
Enumeration Date
16 July 2020
Last Update Date
29 August 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6306215824
Graduation Year
2000 (26 years ago)
PAC ID
6608294475
Group Practice PAC ID
9133393937
Professional Enrollment ID
I20200910000699
Address ID
IL605444206PL24402STXX401
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience34
Completeness75
Years active:5State licenses:1Digital endpointsOther names

1,600 CLINICAL PSYCHOLOGIST in IL

Provider Addresses for DR. JERRY MARK OTOOLE (PSYD)

  • 12816 TIMBER WOOD CIR

    PLAINFIELD, IL 605852974

    Phone: (240) 449-5170

    Type: Mailing

  • 24402 W LOCKPORT ST STE 215

    PLAINFIELD, IL 605444204

    Phone: (630) 621-5824

    Type: Location

  • 5700 CATON FARM RD

    PLAINFIELD, IL 605869905

    Phone: (815) 467-8181

    Type: Location

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.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

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

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2020-09-10

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20200910000699IClinical PsychologistILTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

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 60585)

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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: 9133393937View full group profile
NameSpecialtyState
Clinical PsychologistIL
P S Y C H I A T R YIL
Clinical PsychologistIL
Clinical Social WorkerIL
-CA
Mental Health CounselorIL
Clinical Social WorkerIL

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Frequently asked questions

What identifier follows DR. JERRY MARK OTOOLE (PSYD) across health systems?
The NPI 1790393650 uniquely identifies DR. JERRY MARK OTOOLE (PSYD) in U.S. healthcare data.
Quick check: is DR. JERRY MARK OTOOLE (PSYD) active?
Public NPPES data shows DR. JERRY MARK OTOOLE (PSYD) with an active NPI status right now.
What services align with DR. JERRY MARK OTOOLE (PSYD)'s listing?
DR. JERRY MARK OTOOLE (PSYD)'s public classification highlights Psychologist. Clinical services aligned with this taxonomy classification.
Is DR. JERRY MARK OTOOLE (PSYD) tied to Plainfield, Illinois?
If you are local to Plainfield, Illinois, DR. JERRY MARK OTOOLE (PSYD) may be relevant to your search.
What is the difference between NPI and a medical license?
An NPI is a federal identifier; a medical license is issued by a state and governs where someone may practice.

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