Active NPI
Angie Wang
- Registered Dietitian
- Barrington, IL
National Provider Identifier
1013499243
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 164.007337
- Practice address
- 111 Lions Dr Ste 221
Barrington, IL 60010-3175 - Phone
- (847) 868-3435
- Fax
- (847) 859-5885
- NPI assigned
- Sep 4, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 164.007337 | IL | Primary |
Addresses
Primary practice location
111 Lions Dr Ste 221
Barrington, IL 60010-3175
Mailing address
1685 Henley CT
Wheeling, IL 60090-6910
Phone (858) 880-8700
Other practice location 1
2003 W Fulton St Ste 300
Chicago, IL 60612-2345
Phone (773) 407-6305
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164.007337 | IL | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| PHC of Buffalo Grove Nutrition | Dietitian, Registered | Past | Accepting new patients |
Interoperability endpoints
- lifestancehealth.angiewang@146897.advancedmd-direct.com
Organizations & group practices 1
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.
-
dba Portrait Health Centers
- Registered Dietitian
- Vernon Hills, IL
- NPI 1902107386
Dietitian, Registered
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1536019200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1581465600000",
"number": "1013499243",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1685 HENLEY CT",
"city": "WHEELING",
"state": "IL",
"postal_code": "600906910",
"telephone_number": "858-880-8700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 LIONS DR STE 221",
"city": "BARRINGTON",
"state": "IL",
"postal_code": "600103175",
"telephone_number": "847-868-3435",
"fax_number": "847-859-5885"
}
],
"practiceLocations": [
{
"address_1": "2003 W Fulton St Ste 300",
"address_purpose": "LOCATION",
"city": "Chicago",
"state": "IL",
"postal_code": "606122345",
"country_code": "US",
"telephone_number": "773-407-6305",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WANG",
"first_name": "ANGIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-09-04",
"last_updated": "2020-02-12",
"certification_date": "2020-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "164.007337",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Barrington, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.