Unknown Individual – Psychiatry Physician, NPI 1962504902
Psychiatry Physician
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NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
695, Ivy Lane, Glencoe, New Trier Township, Cook County, Illinois, 60022, United States
GLENCOE, IL 60022
Phone: (847) 790-6757
Fax: (847) 242-0860
Type: Mailing
1105, West Park Avenue, Libertyville, Lake County, Illinois, 60048, United States
SUITE 2
LIBERTYVILLE, IL 60048
Phone: (847) 790-6757
Fax: (847) 242-0860
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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No Medicare enrollment or revalidation data available for this provider in our database.
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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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99442 | Telephone medical discussion with physician, 11-20 minutes | 416 | 53 | $0 |
| 99308 | Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes | 393 | 113 | $0 |
| 99309 | Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes | 363 | 115 | $0 |
| 90792 | Psychiatric diagnostic evaluation with medical services | 52 | 52 | $0 |
| G0407 | Follow-up inpatient consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth | 17 | 17 | $0 |
Insurance plans in this area (ZIP 60022)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| PSYCHIATRY | IL | 90792 | Psychiatric diagnostic evaluation with medical services | 17 | 17 |
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