Delovely Gloria Jackson, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209013987 Issued in IL

Practice address

1400 Otto Blvd
Chicago Heights, IL 60411-3741

Phone

(708) 733-7200

Fax

(708) 733-7222

NPI assigned

Mar 30, 2016

Last updated

May 8, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Specialty Physicians of Illinois LLCGroup PAC ID 4183529456, 114 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: delovely.jackson.1@30520.direct.athenahealth.com
• Direct secure messaging: djackson222901@direct.franciscanalliance.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Specialty Physicians of Illinois, LLC

  • Internal Medicine Physician
  • Greenwood, IN
  • NPI 1124075676

  IL

  Medicare reassignment Care Compare group NPD
• Emerge Medstaffing LLC

  dba Emerge Quick Care

  • Family Medicine Physician
  • Frankfort, IL
  • NPI 1467177311
  Medicare reassignment NPD
• Midwest Express Care 2, Inc

  • Urgent Care Clinic/Center
  • Willowbrook, IL
  • NPI 1548692890
  Medicare reassignment NPD
• New Southtown Medical Group S C

  • Family Medicine Physician
  • Darien, IL
  • NPI 1134508997
  Medicare reassignment NPD
• Prime Healthcare Illinois Medical Group LLC

  • Multi-Specialty Clinic/Center
  • Des Plaines, IL
  • NPI 1023837689
  Medicare reassignment
• Emerge Medstaffing LLC

  • Emergency Medicine Physician
  • Chicago Heights, IL
  • NPI 1780167841
  NPD
• Midwest Express Care 2, Inc

  dba Midwest Express Clinic

  • Urgent Care Clinic/Center
  • Chicago, IL
  • NPI 1659952554
  NPD
• Specialty Physicians of Illinois, LLC

  • Urgent Care Clinic/Center
  • Frankfort, IL
  • NPI 1962024612
  NPD
• Olympia Fields Eyecare, LTD.

  • Ophthalmology Physician
  • Flossmoor, IL
  • NPI 1598762007
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1459296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683504000000",
    "number": "1013370857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35318 EAGLE WAY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606780353",
            "telephone_number": "317-528-4800",
            "fax_number": "317-865-1479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 OTTO BLVD",
            "city": "CHICAGO HEIGHTS",
            "state": "IL",
            "postal_code": "604113741",
            "telephone_number": "708-733-7200",
            "fax_number": "708-733-7222"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18101 Cherrywood Ln",
            "address_purpose": "LOCATION",
            "city": "Homewood",
            "state": "IL",
            "postal_code": "604301504",
            "country_code": "US",
            "telephone_number": "708-768-6902",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "18636 Dixie Hwy",
            "address_purpose": "LOCATION",
            "city": "Homewood",
            "state": "IL",
            "postal_code": "604303741",
            "country_code": "US",
            "telephone_number": "708-647-0571",
            "fax_number": "708-647-0676",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DELOVELY",
        "middle_name": "GLORIA",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-30",
        "last_updated": "2023-05-08",
        "certification_date": "2023-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "277001922",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209013987",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FPN MEDICARE PTAN",
            "identifier": "F400298104",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "djackson222901@Direct.FranciscanAlliance.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1400 Otto Blvd",
            "city": "Chicago Heights",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604113741",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ilenne Noetzel D.D.S. LTD. William H. Slavin D.D.S. LTD.
• Illinois Behavioral Services Inc
• Monica Irving
• Itara42 Home Care Agency
• J and F Professional in Home Care Services for Seniors
• Felicia Jackson
• Gary Edward Jagmin, DDS
• Brittani James, M.D.
• Sharon Michele James, MD
• Dion Jefferson

• Family Nurse Practitioner in Chicago Heights, IL
• Providers in Chicago Heights, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.