1. Home
  2. Directory
  3. Illinois
  4. Bourbonnais
  5. Clinical Neuropsychologist
  6. NPI Profile

DR. JEFFREY DAVID KAZMIERCZAK PSY.D
NPI 1902178015
Clinical Neuropsychologist in Bourbonnais, IL

Active since February 04, 2012Opted out of Medicare · through Jan 1, 2028
19 HERITAGE PLZ, SUITE 211, BOURBONNAIS, IL 60914(815) 933-8760(815) 933-9061 Get Directions Write a Review

NPPES record last updated: April 9, 2012. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Dr. Jeffrey David Kazmierczak Psy.d NPPES

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

DR. JEFFREY DAVID KAZMIERCZAK PSY.D (NPI 1902178015) is an individual clinical neuropsychologist in Bourbonnais, Illinois, licensed in Illinois (071008293) and active in the NPI registry since February 2012. He has opted out of Medicare through January 1, 2028 and remains eligible to order and refer.

NPPES Registry Identity

NPI1902178015
Entity TypeIndividualMale
Primary Taxonomy103G00000X
Provider Legal NameDR. JEFFREY DAVID KAZMIERCZAKCredential: PSY.D
Location Address19 HERITAGE PLZ, SUITE 211Bourbonnais, IL 60914-1369
Mailing Address19 Heritage Plz, Suite 211Bourbonnais, IL 60914-1369 · (815) 933-8760 · Fax (815) 933-9061
Phone(815) 933-8760
Fax(815) 933-9061
Sole ProprietorNo
Enumeration DateFebruary 4, 2012
Last NPPES UpdateApril 9, 2012
✔ NPI 1902178015 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 7

★ Primary SpecialtyClinical NeuropsychologistBehavioral Health & Social Service Providers
Taxonomy Code103G00000X
License✔ Licensed in IL · 071008293
Definition
A clinical psychologist who applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to normal and abnormal functioning of the central nervous system. The specialty is dedicated to enhancing the understanding of brain-behavior relationships and the application of such knowledge to human problems.
Also ListedPsychologist · Adult Development & AgingTaxonomy 103TA0700X
Also ListedPsychologist · ClinicalTaxonomy 103TC0700X · License 071008293 (IL)
Also ListedPsychologist · CounselingTaxonomy 103TC1900X
Also ListedPsychologist · Clinical Child & AdolescentTaxonomy 103TC2200X
Also ListedPsychologist · ForensicTaxonomy 103TF0200X · License 071008293 (IL)
Also ListedPsychologist · RehabilitationTaxonomy 103TR0400X
19 HERITAGE PLZ, Bourbonnais, IL 60914
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Jeffrey David Kazmierczak Psy.d has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 1, 2014 through January 1, 2028.

Opt-Out Effective DateJanuary 1, 2014
Opt-Out In Effect ThroughJanuary 1, 2028Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JOHN P. HUNG, M.D.,S.C.
Otolaryngology (Otolaryngic Allergy)
19 HERITAGE PLZ, SUITE 210
BOURBONNAIS, IL 60914
Kankakee County (815) 932-1516

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 Jeffrey Kazmierczak's NPI number?

The NPI number for Jeffrey Kazmierczak is 1902178015. It was assigned to this individual provider in the NPPES registry on February 4, 2012.

Where is Jeffrey Kazmierczak located?

Jeffrey Kazmierczak practices at 19 Heritage Plz Suite 211, Bourbonnais, IL 60914. The listed phone number is (815) 933-8760.

What is Jeffrey Kazmierczak's specialty?

The primary specialty registered for this NPI is Clinical Neuropsychologist with taxonomy code 103G00000X.

Is Jeffrey Kazmierczak enrolled in Medicare?

No. Jeffrey Kazmierczak has opted out of Medicare through January 1, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Jeffrey Kazmierczak was last updated on April 9, 2012. NPI Profile syncs with the weekly NPPES data releases published by CMS.