Melissa Coniaris, RN
Individual provider Active NPI Family Nurse Practitioner · River Forest, IL
NPI 1063165017 · NPPES record last updated Apr 12, 2022
Key facts
- NPI
- 1063165017
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 209.024945 (IL)
- Practice address
- 7343 Lake St
River Forest, IL 60305-2206 - Phone
- (708) 231-8908
- NPI assigned
- Jan 31, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220505001568 | IL | Practitioner - Nurse Practitioner | 6608263991 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 041368468 | IL | MD | Pediatric Registered Nurse |
| 209.024945 | IL | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Midwest Express Care 2, Inc | Current |
Accepting new patients | |
| Midwest Express Care 2, Inc | Current |
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
- https://fhir4.healow.com/fhir/r4/FHIBCD/Endpoint/FHIBCD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 209.024945 | IL | Yes |
| 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
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Willowbrook |
Other providers in River Forest, IL
- Chicago Neurological Services, LTD
- Patrick Chun
- Patrick J Clark
- Sarah Clatanoff
- Elizabeth Coleman
- Connect Hearing, Inc.
- Christine Lee Conte
- Pamela A Cools
- Amy Johann Cortis
- Courtney R Villari DDS
All providers in River Forest, IL · Family Nurse Practitioner in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 12, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.