JXP HEALTHY MINDS PC , NPI 1336301969 — JXP HEALTHY MINDS PC in CHICAGO (IL)

NPI 1336301969

11+ Years Experience Organization

JXP HEALTHY MINDS PC

Other organization name: JXP HEALTHY MINDS PC. Name type code: 3 - doing business as (d/b/ a) name.

06/25/2008
PROVIDER ENUMERATION DATE
06/25/2008
LAST UPDATE DATE
1336301969
NPI NUMBER

About JXP HEALTHY MINDS PC

Parent organization: JXP HEALTHY MINDS PC.

JXP HEALTHY MINDS PC is a provider established in CHICAGO, IL. The NPI number of JXP HEALTHY MINDS PC is 1336301969 and was assigned on 06/25/2008. The practitioners primary taxonomy code is: 251S00000X with license number: 71006196 IL .

Mailing address

  • City: CHICAGO
  • State: IL
  • Postal code: 606225102
  • Phone: 3124928081
  • Fax: 3124928083
  • Address: 819 N ASHLAND AVE STE 201

Primary Practice Address

  • Region : CHICAGO, IL
  • NPI : 1336301969
  • Phone : 3124928081
  • Fax : 3124928083
  • Postalcode : 606225102
  • Address : 819 N ASHLAND AVE STE 201

Additional identifiers

  • Identifier: 1831260025
  • Code / Type : 1 - other
  • Identifier state : IL
  • Identifier issuer: JULIE A XIQUES-PRIETO PSY,D

Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Additional identifiers # 2

  • Identifier: 1184607608
  • Code / Type : 1 - other
  • Identifier state : IL
  • Identifier issuer : MERCEDEZ MARTINEZ MD

Provider taxonomy - Community/Behavioral Health

  • Taxonomy code: 251S00000X
  • License number: 71006196
  • License state: IL

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Taxonomy description: A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.

Contacts:

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  • JXP HEALTHY MINDS PC
  • Address : 819 N ASHLAND AVE STE 201
  • Region : CHICAGO, IL
  • NPI : 1336301969
  • Phone : 3124928081
  • Fax : 3124928083
  • Postalcode : 606225102

Authorized official :

{:AUTHORIZED_OFFICIAL_FIRST_NAME:} {:AUTHORIZED_OFFICIAL_MIDDLE_NAME:} {:AUTHORIZED_OFFICIAL_LAST_NAME:}
  • Phone : 3124928081
  • Title or position : LICENSED CLINICAL PSYCHOLOGIST
  • Credentials : PSY,D

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address819 N ASHLAND AVE STE 201
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameCHICAGO
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameIL
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code606225102
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number3124928081
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number3124928083
The fax number associated with the location address of the provider being identified.
NPI1336301969
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1251S00000X
A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.
Provider Enumeration Date06/25/2008
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated06/25/2008
The date that a record was last updated or changed.
Entity TypeOrganization
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Is Organization SubpartY
The "Is the organization a subpart?" question must be answered. If the organization is a subpart, the Parent Organization Legal Business Name (LBN) and Parent Organization Taxpayer Identification Number (TIN) fields must be completed. The Parent Organization LBN and TIN fields can only be completed if the answer to the subpart question is Yes. Many organization health care providers who apply for NPIs are not legal entities themselves but are parts of other organization health care providers that are legal entities (the "parents"). Here are three examples of organization health care providers that may be considered subparts and may apply for NPIs if so directed by their "parents": (1) The psychiatric unit in a hospital is not a legal entity but is part of the hospital (the "parent"), which is a legal entity. The legal entity must obtain an NPI. The psychiatric unit is an example of a subpart that could have its own NPI if the hospital determines that it should. (2) A group practice that is not a sole proprietorship has a main location and could have other offices in different locations, but each office is not a separate legal entity; instead, each office is part of the corporation (the "parent") which is a legal entity. The offices are examples of subparts that could have their own NPIs if the main location determines that they should. (3) A pharmacy fills prescriptions for patients whose physicians have prescribed medications for them and may also rent or sell durable medical equipment to patients whose physicians have ordered such equipment for them. Neither the pharmacy line of business nor the DME line of business represent legal entities; instead, both lines of business are part of an organization (the "parent") that is a legal entity. Each line of business represents a different Healthcare Provider Taxonomy or area of specialization that often submits its own electronic claims to health plans. The "parent"-we don"t know who the parent is in this example-must ensure that each subpart that submits its own claims to health plans has its own NPI.
Provider Organization Name (Legal Business Name)JXP HEALTHY MINDS PC
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider Other Organization NameJXP HEALTHY MINDS PC
Other name by which the organization provider is or has been known.
Provider Other Organization Name Type Code3
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address819 N ASHLAND AVE STE 201
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City NameCHICAGO
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameIL
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code606225102
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number3124928081
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number3124928083
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Authorized Official Last NameXIQUES-PRIETO
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameJULIE
The first name of the authorized official
Authorized Official Middle NameA.
The middle name of the authorized official
Authorized Official Title or PositionLICENSED CLINICAL PSYCHOLOGIST
The title or position of the authorized official
Authorized Official Name Prefix TextDR.
Authorized Official Name Prefix Text
Authorized Official Credential TextPSY,D
Authorized Official Credential Text
Authorized Official Telephone Number3124928081
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code #1251S00000X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Community/Behavioral Health
A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.
Provider License Number 171006196
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1IL
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Other Provider Identifier 11831260025
Other Provider Identifier #1
Other Provider Identifier Type 11
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 1IL
Other Provider Identifier State #1
Other Provider Identifier Issuer 1JULIE A XIQUES-PRIETO PSY,D
Other Provider Identifier Issuer #1
Other Provider Identifier 21184607608
Other Provider Identifier #2
Other Provider Identifier Type 21
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 2IL
Other Provider Identifier State #2
Other Provider Identifier Issuer 2MERCEDEZ MARTINEZ MD
Other Provider Identifier Issuer #2
X

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