| Rockford Psychiatric Medical Services, S.c. | |
|
1639 N Alpine Rd Ste 260 Rockford IL 61107-1481 | |
| (815) 395-1500 | |
| (815) 395-1415 |
| Full Name | Rockford Psychiatric Medical Services, S.c. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1639 N Alpine Rd Ste 260, Rockford, Illinois |
| Authorized Official Name and Position | Brandy L Marriner (CREDENTIALING MANAGER) |
| Authorized Official Contact | 6309124241 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rockford Psychiatric Medical Services, S.c. 1639 N Alpine Rd Ste 260 Rockford IL 61107-1481 Ph: (630) 912-4241 | Rockford Psychiatric Medical Services, S.c. 1639 N Alpine Rd Ste 260 Rockford IL 61107-1481 Ph: (815) 395-1500 |
| NPI Number | 1821391442 |
|---|---|
| Provider Enumeration Date | 12/21/2010 |
| Last Update Date | 11/07/2024 |
| Certification Date | 11/07/2024 |
| Medicare PECOS PAC ID | 6901089515 |
|---|---|
| Medicare Enrollment ID | O20110318000777 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821391442 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 036083961 (Illinois) | Primary |
| Provider Name | Richard Jaconette |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1578785432 PECOS PAC ID: 3971408915 Enrollment ID: I20031203000630 |
| Provider Name | Sharyl E Balkin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740396134 PECOS PAC ID: 5890689376 Enrollment ID: I20040216000044 |
| Provider Name | Paul Berkowitz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1275564197 PECOS PAC ID: 8820983471 Enrollment ID: I20040220000940 |
| Provider Name | William Giakas |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1821009127 PECOS PAC ID: 4385617471 Enrollment ID: I20041223000190 |
| Provider Name | Dennis R Brightwell |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1841288420 PECOS PAC ID: 4981615028 Enrollment ID: I20060605000250 |
| Provider Name | Corrin L Scavo |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1073713236 PECOS PAC ID: 1153460787 Enrollment ID: I20091120000207 |
| Provider Name | Pedro L Dago |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689637639 PECOS PAC ID: 1355473463 Enrollment ID: I20100723000902 |
| Provider Name | Lauran Elisabeth Mejia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114358264 PECOS PAC ID: 1759518798 Enrollment ID: I20131218000946 |
| Provider Name | Grace Marie F Roxas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639543937 PECOS PAC ID: 8820390750 Enrollment ID: I20160108000643 |
| Provider Name | Eric L Martinez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952761868 PECOS PAC ID: 4486953502 Enrollment ID: I20160425000691 |
| Provider Name | Ana M Mirica |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346507803 PECOS PAC ID: 6608014543 Enrollment ID: I20170412001865 |
| Provider Name | Babatunde Ogundipe |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1497911267 PECOS PAC ID: 7315292331 Enrollment ID: I20180628002908 |
| Provider Name | Donna Catherine Czech |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396104501 PECOS PAC ID: 3971800566 Enrollment ID: I20180823002267 |
| Provider Name | Candice J Holder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376976530 PECOS PAC ID: 9032353206 Enrollment ID: I20190730000172 |
| Provider Name | Jazira B Sultanova |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508238221 PECOS PAC ID: 3678874096 Enrollment ID: I20201204000302 |
| Provider Name | Katelynn Reyes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598214082 PECOS PAC ID: 5799199949 Enrollment ID: I20210128002450 |
| Provider Name | Shannon Marie Ferriter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417435652 PECOS PAC ID: 5496169666 Enrollment ID: I20210129000305 |
| Provider Name | Erin Cathleen Richards |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023533346 PECOS PAC ID: 1052729654 Enrollment ID: I20210420002776 |
| Provider Name | Oladunni F Boladale |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639743107 PECOS PAC ID: 8224436597 Enrollment ID: I20211018002104 |
| Provider Name | Susan Gierczyk |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124697719 PECOS PAC ID: 4981092293 Enrollment ID: I20211019001115 |
| Provider Name | Julie Mensching |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295409282 PECOS PAC ID: 7618369687 Enrollment ID: I20220125001400 |
| Provider Name | Angela Elaine Gilbert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356912026 PECOS PAC ID: 3274927025 Enrollment ID: I20220222000930 |
| Provider Name | Emmanuel Bentil Ofori Danso |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376299933 PECOS PAC ID: 3072994383 Enrollment ID: I20220718003727 |
| Provider Name | Debra Stambaugh |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285917294 PECOS PAC ID: 8123304243 Enrollment ID: I20221005001297 |
| Provider Name | Angela Sohn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902522469 PECOS PAC ID: 3779954581 Enrollment ID: I20230113000756 |
| Provider Name | Chibogu Victoria Obianwu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710606298 PECOS PAC ID: 4981075223 Enrollment ID: I20230124000708 |
| Provider Name | Samuel Assam |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881323905 PECOS PAC ID: 4082086772 Enrollment ID: I20230206002072 |
| Provider Name | Debbie K Chirikos |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275584153 PECOS PAC ID: 1557735115 Enrollment ID: I20230321002973 |
| Provider Name | Samantha O'brien |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336848035 PECOS PAC ID: 8022473339 Enrollment ID: I20230420000514 |
| Provider Name | Ganime Nazif |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770856825 PECOS PAC ID: 6709241359 Enrollment ID: I20230503002541 |
| Provider Name | Justin Hahn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801500780 PECOS PAC ID: 3072979384 Enrollment ID: I20230511001374 |
| Provider Name | Grant Tyler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346641644 PECOS PAC ID: 6406179498 Enrollment ID: I20230516001312 |
| Provider Name | Stacey A Price |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023703949 PECOS PAC ID: 9133588510 Enrollment ID: I20230703000945 |
| Provider Name | Andres Misquez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629638200 PECOS PAC ID: 7214390103 Enrollment ID: I20230824003186 |
| Provider Name | Katherine Lyn Dorwaldt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386100295 PECOS PAC ID: 4284097049 Enrollment ID: I20230825002309 |
| Provider Name | Rupinder Grewal |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689136392 PECOS PAC ID: 8729317789 Enrollment ID: I20230906003623 |
| Provider Name | Christine Marie Reed |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609324383 PECOS PAC ID: 0143684233 Enrollment ID: I20230907002398 |
| Provider Name | Francesco Incandela |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1871153262 PECOS PAC ID: 6305170812 Enrollment ID: I20230907002820 |
| Provider Name | Naomi Cohen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447034970 PECOS PAC ID: 4789048497 Enrollment ID: I20230914000264 |
| Provider Name | Suzanne Marie Butler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063195931 PECOS PAC ID: 1052768835 Enrollment ID: I20231116000342 |
| Provider Name | Sara Marie Pottinger |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1396073128 PECOS PAC ID: 4082066113 Enrollment ID: I20240115000032 |
| Provider Name | Alexandra Kathryn Lundsteen |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1770196537 PECOS PAC ID: 7113379264 Enrollment ID: I20240115000540 |
| Provider Name | Susan A Cuevas |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1518908201 PECOS PAC ID: 3173971116 Enrollment ID: I20240115000749 |
| Provider Name | Jean A Cooper |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1316050933 PECOS PAC ID: 5395197461 Enrollment ID: I20240115001208 |
| Provider Name | Celinda Nadine Smith |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1184387102 PECOS PAC ID: 8527410695 Enrollment ID: I20240115001361 |
| Provider Name | Lauryn Elyse Lewis |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1780385609 PECOS PAC ID: 8325490402 Enrollment ID: I20240115001448 |
| Provider Name | Laura Elizabeth Van Dame |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1467156687 PECOS PAC ID: 0143672154 Enrollment ID: I20240116000740 |
| Provider Name | Natalie Christine Barbato |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1528672029 PECOS PAC ID: 0042662900 Enrollment ID: I20240117001084 |
| Provider Name | Christine Lynn Vinci |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1154670172 PECOS PAC ID: 0345692117 Enrollment ID: I20240117001701 |
| Provider Name | Matthew N Caston |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1154881233 PECOS PAC ID: 0749632537 Enrollment ID: I20240117002273 |
| Provider Name | Sean Michael Paras |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770352072 PECOS PAC ID: 8426400227 Enrollment ID: I20240117002695 |
| Provider Name | Scott Charles Kainovic |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1164155982 PECOS PAC ID: 0446602197 Enrollment ID: I20240117004585 |
| Provider Name | Tessa R Bailey |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1609352236 PECOS PAC ID: 1355793043 Enrollment ID: I20240118001114 |
| Provider Name | Elizabeth Anne Johansson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1164143806 PECOS PAC ID: 3375995012 Enrollment ID: I20240118002895 |
| Provider Name | Colin Eric Jensen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922293950 PECOS PAC ID: 5799138020 Enrollment ID: I20240201004635 |
| Provider Name | Michelle Diaz |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1902447469 PECOS PAC ID: 3476996679 Enrollment ID: I20240205002412 |
| Provider Name | Zainab Taiwo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275300089 PECOS PAC ID: 8426491457 Enrollment ID: I20240207001219 |
| Provider Name | Patricia Pasillas Cardenas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447972641 PECOS PAC ID: 0941644835 Enrollment ID: I20240219003517 |
| Provider Name | Asha B Patel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275300675 PECOS PAC ID: 8628412293 Enrollment ID: I20240222001409 |
| Provider Name | Sabrina Michele Marlow |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1801360532 PECOS PAC ID: 5799121059 Enrollment ID: I20240308000628 |
| Provider Name | Brittany Fromm |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316508716 PECOS PAC ID: 9830537919 Enrollment ID: I20240409002189 |
| Provider Name | Adrian Marcus Cardenas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922596311 PECOS PAC ID: 8224477575 Enrollment ID: I20240418003475 |
| Provider Name | Deanne Marie Wolter |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1689942831 PECOS PAC ID: 9830539824 Enrollment ID: I20240424001342 |
| Provider Name | Zainab Lee |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669975066 PECOS PAC ID: 0941640882 Enrollment ID: I20240425002993 |
| Provider Name | Joan Torrato |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568232858 PECOS PAC ID: 3779923479 Enrollment ID: I20240429001794 |
| Provider Name | Brittany Lampkin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1518411016 PECOS PAC ID: 1759721038 Enrollment ID: I20240503000704 |
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