Individual provider Active NPI

Melissa Coniaris, RN

  • Family Nurse Practitioner
  • River Forest, IL
National Provider Identifier
1063165017
Registry record updated Apr 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209.024945 Issued in IL
Practice address
7343 Lake St
River Forest, IL 60305-2206
Phone
(708) 231-8908
NPI assigned
Jan 31, 2022
Last updated
Apr 12, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209.024945 IL Primary
Pediatric Registered Nurse 163WP0200X 041368468 IL

Addresses

Primary practice location

7343 Lake St
River Forest, IL 60305-2206

Mailing address

40 75TH St
Willowbrook, IL 60527-2325

Other practice location 1

40 75th St
Willowbrook, IL 60527-2325
Phone (630) 581-5372

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL Willowbrook

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20220505001568 IL Practitioner - Nurse Practitioner 6608263991 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
041368468ILMDPediatric Registered Nurse
209.024945ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Express Care 2, Inc CurrentSince Jan 26, 2022 Accepting new patients
Midwest Express Care 2, Inc CurrentSince Jan 26, 2022 Accepting new patients

Locations

2070 N State Route 50
Ste 500
Bourbonnais, IL 60914
Phone (779) 236-4094

219 W Chicago Ave
Chicago, IL 60654
Phone (312) 878-1945

7343 Lake St
River Forest, IL 60305
Phone (708) 231-8908

40 75th St
Willowbrook, IL 60527
Phone (630) 326-5312

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/FHIBCD/Endpoint/FHIBCD

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1643587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649721600000",
    "number": "1063165017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 75TH ST",
            "city": "WILLOWBROOK",
            "state": "IL",
            "postal_code": "605272325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7343 LAKE ST",
            "city": "RIVER FOREST",
            "state": "IL",
            "postal_code": "603052206",
            "telephone_number": "708-231-8908"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "40 75th St",
            "address_purpose": "LOCATION",
            "city": "Willowbrook",
            "state": "IL",
            "postal_code": "605272325",
            "country_code": "US",
            "telephone_number": "630-581-5372",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CONIARIS",
        "first_name": "MELISSA",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-31",
        "last_updated": "2022-04-12",
        "certification_date": "2022-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.024945",
            "primary": true
        },
        {
            "code": "163WP0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Pediatrics",
            "state": "IL",
            "license": "041368468",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Willowbrook",
            "affiliation": "N",
            "address_1": "40 75th St",
            "city": "Willowbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605272325",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in River Forest, IL

Sources for this page

Verify at the official NPI Registry.