Dr Lisa Marie Petrongelli, PSYD, APRN-BC, FPA is a medicare enrolled "Nurse Practitioner" provider in Algonquin, Illinois. Her current practice location is
1317 S Main St, Algonquin, Illinois. You can reach out to her office (for appointments etc.) via phone at
(847) 748-4069.
Dr Lisa Marie Petrongelli is licensed to practice in Illinois (license number 209004881) 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 1306281332.
Healthcare Provider's Profile
| Full Name | Dr Lisa Marie Petrongelli |
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| Gender | Female |
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| Speciality | Nurse Practitioner |
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| Location | 1317 S Main St, Algonquin, 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: 1306281332
- Provider Enumeration Date: 05/03/2013
- Last Update Date: 07/20/2021
Medicare PECOS Information:
- PECOS PAC ID: 1153229885
- Enrollment ID: I20031219000456
Medical Identifiers
Medical identifiers for Dr Lisa Marie Petrongelli such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1306281332 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 103T00000X | Psychologist | (* (Not Available)) | Secondary |
| 103TA0400X | Psychologist - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 103TC2200X | Psychologist - Clinical Child & Adolescent | (* (Not Available)) | Secondary |
| 103TH0100X | Psychologist - Health Service | (* (Not Available)) | Secondary |
| 103TP2701X | Psychologist - Group Psychotherapy | (* (Not Available)) | Secondary |
| 363LA2200X | Nurse Practitioner - Adult Health | 277000902 (Illinois) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | 277000902 (Illinois) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | 277000902 (Illinois) | Secondary |
| 363LW0102X | Nurse Practitioner - Women's Health | 277000902 (Illinois) | Secondary |
| 363L00000X | Nurse Practitioner | 209004881 (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. Dr Lisa Marie Petrongelli allows following entities to bill medicare on her behalf.
| Entity Name | Fred J Halloran Md Sc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1295906774
PECOS PAC ID: 5799699831
Enrollment ID: O20031113000658 |
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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. Dr Lisa Marie Petrongelli 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 |
|---|
Dr Lisa Marie Petrongelli, PSYD, APRN-BC, FPA
1015 S Evergreen Ave,
Arlington Heights, IL 60005-3144
Ph: (847) 506-1400 | Dr Lisa Marie Petrongelli, PSYD, APRN-BC, FPA
1317 S Main St,
Algonquin, IL 60102-2758
Ph: (847) 748-4069 |
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