Active NPI
Grace Diala
- Nurse Practitioner
- Flossmoor, IL
National Provider Identifier
1013663178
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 209.024830
- Practice address
- 3710 Lismore St
Flossmoor, IL 60422-4311 - Phone
- (708) 527-0354
- NPI assigned
- Feb 28, 2022
- 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 209.024830 | IL | Primary |
Addresses
Primary practice location
3710 Lismore St
Flossmoor, IL 60422-4311
Mailing address
3710 Lismore St
Flossmoor, IL 60422-4311
Phone (708) 527-0354
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013663178 | Medicaid | IL |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Flossmoor | Health Information Exchange (HIE) | |
| CONNECT URL | Flossmoor | Health Information Exchange (HIE) |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209.024830 | IL | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1646006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649030400000",
"number": "1013663178",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3710 LISMORE ST",
"city": "FLOSSMOOR",
"state": "IL",
"postal_code": "604224311",
"telephone_number": "708-527-0354"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3710 LISMORE ST",
"city": "FLOSSMOOR",
"state": "IL",
"postal_code": "604224311",
"telephone_number": "708-527-0354"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIALA",
"first_name": "GRACE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-02-28",
"last_updated": "2022-04-04",
"certification_date": "2022-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "IL",
"license": "209.024830",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1013663178",
"state": "IL"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "Flossmoor",
"affiliation": "N",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"useOtherDescription": "Flossmoor",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Flossmoor",
"address_1": "3710 Lismore St",
"city": "Flossmoor",
"state": "IL",
"country_code": "US",
"postal_code": "604224311",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "Flossmoor",
"affiliation": "N",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "3710 Lismore St",
"city": "Flossmoor",
"state": "IL",
"country_code": "US",
"postal_code": "604224311",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Flossmoor, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.