| Decatur Psychiatry Ltd | |
|
363 S Main St Ste 240 Decatur IL 62523-1492 | |
| (217) 809-0429 | |
| (217) 422-0041 |
| Full Name | Decatur Psychiatry Ltd |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 363 S Main St Ste 240, Decatur, Illinois |
| Authorized Official Name and Position | Anjum Bashir (OWNER) |
| Authorized Official Contact | 2178090429 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Decatur Psychiatry Ltd 363 S Main St Ste 240 Decatur IL 62523-1492 Ph: (217) 809-0429 | Decatur Psychiatry Ltd 363 S Main St Ste 240 Decatur IL 62523-1492 Ph: (217) 809-0429 |
| NPI Number | 1770638686 |
|---|---|
| Provider Enumeration Date | 01/24/2007 |
| Last Update Date | 05/17/2023 |
| Certification Date | 05/17/2023 |
| Medicare PECOS PAC ID | 8426065186 |
|---|---|
| Medicare Enrollment ID | O20060321000610 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770638686 | NPI | - | NPPES |
| 036105848 | Medicaid | IL | |
| 213272 | Other | IL | MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 036105848 (Illinois) | Primary |
| Provider Name | Anjum Bashir |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1568440683 PECOS PAC ID: 3678580347 Enrollment ID: I20060322000022 |
| Provider Name | Adrian M Byrd |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194992503 PECOS PAC ID: 1557435823 Enrollment ID: I20080805000080 |
| Provider Name | Nichele D Hawbaker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407097264 PECOS PAC ID: 5597810374 Enrollment ID: I20090831000299 |
| Provider Name | Tracy L Pulliam |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639458623 PECOS PAC ID: 5193985471 Enrollment ID: I20120323000064 |
| Provider Name | Thomas K Stewart |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265677421 PECOS PAC ID: 6608024955 Enrollment ID: I20120912000303 |
| Provider Name | Jaymie L Mccammon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194099853 PECOS PAC ID: 6901043876 Enrollment ID: I20130513000579 |
| Provider Name | Katy J Lambert |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407076409 PECOS PAC ID: 2365768611 Enrollment ID: I20150303001821 |
| Provider Name | Annie Michele Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902340730 PECOS PAC ID: 3173885506 Enrollment ID: I20180326000263 |
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