SOUTHPARK PSYCHOLOGY LTD
NPI 1558470419
Psychologist - Counseling in Moline, IL

Active since August 30, 2006
2100 52ND AVE, MOLINE, IL 61265(309) 797-2900(309) 797-2147 Get Directions Write a Review

NPPES record last updated: January 26, 2018. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Southpark Psychology Ltd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHPARK PSYCHOLOGY LTD (NPI 1558470419) is a healthcare organization registered as a counseling in Moline, Illinois and active in the NPI registry since August 2006. The organization lists Carl Vincent, Owner, as its authorized official.

NPPES Registry Identity

NPI1558470419
Entity TypeOrganization
Primary Taxonomy103TC1900X
Legal Business NameSOUTHPARK PSYCHOLOGY LTD
Location Address2100 52ND AVEMoline, IL 61265-6366
Mailing Address2100 52nd AveMoline, IL 61265-6366 · (309) 797-2900 · Fax (309) 797-2147
Fax(309) 797-2147
Organization SubpartNo
Authorized OfficialCarl VincentOwner · (309) 797-2900
Enumeration DateAugust 30, 2006
Last NPPES UpdateJanuary 26, 2018
✔ NPI 1558470419 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyPsychologist · CounselingBehavioral Health & Social Service Providers
Taxonomy Code103TC1900X
Definition
A psychologist who specializes in general practice and health service. It focuses on how people function both personally and in their relationships at all ages. Counseling psychology addresses the emotional, social, work, school and physical health concerns people may have at different stages in their lives, focusing on typical life stresses and more severe issues with which people may struggle as individuals and as a part of families, groups and organizations. Counseling psychologists help people with physical, emotional and mental health issues improve their sense of well-being, alleviate feelings of distress and resolve crises. They also provide assessment, diagnosis, and treatment of more severe psychological symptoms.
Also ListedCounselor · ProfessionalTaxonomy 101YP2500X
Also ListedPsychologist · ClinicalTaxonomy 103TC0700X
Also ListedSocial Worker · ClinicalTaxonomy 1041C0700X
2100 52ND AVE, Moline, IL 61265

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Southpark Psychology Ltd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

21

Medicare enrollment records show 21 clinicians reassign Medicare billing to Southpark Psychology Ltd, which bills Medicare for the services they deliver. Of these, 5 practice at this address and 14 within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 4

Mental Health Counselor11
Clinical Social Worker7
Clinical Psychologist2
Marriage and Family Therapist1

Nearest to this location (20)

See all 21
Mental Health Counselor
NPI 1912918814
2100 52ND AVE
Moline, IL 61265
(309) 797-2900
✔ PECOS✔ Accepts MedicareSame address
Mental Health Counselor
NPI 1831395524
2100 52ND AVE
Moline, IL 61265
(309) 797-2900
✔ PECOS✔ Accepts MedicareSame address
Clinical Psychologist
NPI 1528078987
2100 52ND AVE
Moline, IL 61265
(309) 797-2900
✔ PECOS✔ Accepts MedicareSame address
Mental Health Counselor
NPI 1922019991
2100 52ND AVE
Moline, IL 61265
(309) 797-2900
✔ PECOS✔ Accepts MedicareSame address
Clinical Social Worker
NPI 1477668127
2100 52ND AVE
Moline, IL 61265
(309) 797-2900
✔ PECOS✔ Accepts MedicareSame address
Clinical Social Worker
NPI 1740458082
4703 44TH ST
Rock Island, IL 61201
(309) 786-0770
✔ PECOS✔ Accepts Medicare1.9 mi
Mental Health Counselor
NPI 1083755433
4709 44 ST SUITE #5
Rock Island, IL 61201
(309) 793-3460
✔ PECOS✔ Accepts Medicare1.9 mi
Mental Health Counselor
NPI 1457415325
550 OAKLAWN AVE
East Moline, IL 61244
(309) 792-1074
✔ PECOS✔ Accepts Medicare3.2 mi
Clinical Social Worker
NPI 1912775537
705 OAKLAWN AVE
East Moline, IL 61244
(309) 737-5676
✔ PECOS✔ Accepts Medicare3.6 mi
Mental Health Counselor
NPI 1770832198
2701 17TH ST
Rock Island, IL 61201
(309) 779-2800
✔ PECOS✔ Accepts Medicare3.8 mi
Mental Health Counselor
NPI 1366872640
2701 17TH ST
Rock Island, IL 61201
(309) 779-3200
✔ PECOS✔ Accepts Medicare3.8 mi
Clinical Social Worker
NPI 1306381819
2701 17TH ST
Rock Island, IL 61201
(309) 779-3033
✔ PECOS✔ Accepts Medicare3.8 mi
Clinical Social Worker
NPI 1881024875
1312 ESPLANADE AVE
Davenport, IA 52803
(563) 210-1291
✔ PECOS✔ Accepts Medicare5.5 mi
Mental Health Counselor
NPI 1649757725
3333 155TH AVE
Milan, IL 61264
(309) 623-4459
✔ PECOS✔ Accepts Medicare7.2 mi
Clinical Social Worker
NPI 1801954938
128 S STATE ST
Geneseo, IL 61254
(309) 945-7059
✔ PECOS✔ Accepts Medicare18 mi
Mental Health Counselor
NPI 1275012692
137 E COLLEGE ST
Kewanee, IL 61443
(309) 852-4331
✔ PECOS✔ Accepts Medicare34 mi
Mental Health Counselor
NPI 1598249138
325 IL ROUTE 2
Dixon, IL 61021
(815) 284-6611
✔ PECOS✔ Accepts Medicare61 mi
Clinical Social Worker
NPI 1881966836
1953 1ST AVE SE
Cedar Rapids, IA 52402
(319) 364-1953
✔ PECOS✔ Accepts Medicare69 mi
Mental Health Counselor
NPI 1083883292
909 MAIN STREET SUITE 505
Dubuque, IA 52001
(563) 556-0699
✔ PECOS✔ Accepts Medicare72 mi
Marriage and Family Therapist
NPI 1972804334
1516 S BOSTON AVE STE 1
Tulsa, OK 74119
(918) 561-6000
✔ PECOS✔ Accepts Medicare471 mi
See all 21 clinicians

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southpark Psychology Ltd's NPI number?

The NPI number for Southpark Psychology Ltd is 1558470419. It was assigned to this organization in the NPPES registry on August 30, 2006.

Where is Southpark Psychology Ltd located?

Southpark Psychology Ltd is located at 2100 52nd Ave, Moline, IL 61265. The listed phone number is (309) 797-2900.

What is Southpark Psychology Ltd's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Counseling, with taxonomy code 103TC1900X.

Is Southpark Psychology Ltd enrolled in Medicare?

Yes. Southpark Psychology Ltd is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Southpark Psychology Ltd?

According to the CMS Revalidation Reassignment List (October 2026 release), 21 clinicians in 4 Medicare specialties reassign their Medicare billing to Southpark Psychology Ltd. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Mental Health Counselor (11), Clinical Social Worker (7) and Clinical Psychologist (2). Of these, 5 practice at this address and 14 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Southpark Psychology Ltd accept?

Health plans from Ambetter Health and Ambetter Health of Delaware list Southpark Psychology Ltd as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Southpark Psychology Ltd was last updated on January 26, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.