Kelly Bauman, PSYD is a medicare enrolled "Psychologist - Clinical" provider in Crystal Lake, Illinois. Her current practice location is
457 Coventry Ln Ste 115, Crystal Lake, Illinois. You can reach out to her office (for appointments etc.) via phone at
(815) 245-4825.
Kelly Bauman is licensed to practice in Illinois (license number 071008887) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1174802730.
Healthcare Provider's Profile
| Full Name | Kelly Bauman |
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| Gender | Female |
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| Speciality | Psychologist - Clinical |
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| Location | 457 Coventry Ln Ste 115, Crystal Lake, Illinois |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1174802730
- Provider Enumeration Date: 08/12/2011
- Last Update Date: 05/21/2021
Medicare PECOS Information:
- PECOS PAC ID: 3274859277
- Enrollment ID: I20150311000286
Medical Identifiers
Medical identifiers for Kelly Bauman such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1174802730 | NPI | - | NPPES |
| 071008887 | Other | IL | STATE LICENSE |
| 166.000207 | Other | IL | STATE LICENSE NUMBER |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 106H00000X | Marriage & Family Therapist | 166.000207 (Illinois) | Secondary |
| 103TC0700X | Psychologist - Clinical | 071008887 (Illinois) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Kelly Bauman allows following entities to bill medicare on her behalf.
| Entity Name | Bauman Psychotherapy Collaborations Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1235701905
PECOS PAC ID: 0143610915
Enrollment ID: O20211209002480 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kelly Bauman is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Kelly Bauman, PSYD
720 S Eastwood Dr Ste 166,
Woodstock, IL 60098-4635
Ph: (815) 245-4825 | Kelly Bauman, PSYD
457 Coventry Ln Ste 115,
Crystal Lake, IL 60014-7571
Ph: (815) 245-4825 |
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