Active NPI
Mitzie Ralph Fairfield, NP
- Women's Health Nurse Practitioner
- Champaign, IL
National Provider Identifier
1063580058
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Women's Health Nurse Practitioner
- License
- 209-000689
- Practice address
- 302 E. Stoughton
Champaign, IL 61820 - Phone
- (217) 359-8022
- NPI assigned
- Nov 30, 2006
- 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 |
|---|---|---|---|---|
| Women's Health Nurse Practitioner | 363LW0102X | 209-000689 | IL | Primary |
Addresses
Primary practice location
302 E. Stoughton
Champaign, IL 61820
Mailing address
615 County Rd 3400 North
Foosland, IL 61845
Phone (217) 897-1096
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
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209-000689 | IL | MD | Women's Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Planned Parenthood of Illinois | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Clinic/Center
- Chicago, IL
- NPI 1790754745
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164844800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1224806400000",
"number": "1063580058",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "615 COUNTY RD 3400 NORTH",
"city": "FOOSLAND",
"state": "IL",
"postal_code": "61845",
"telephone_number": "217-897-1096"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "302 E. STOUGHTON",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "61820",
"telephone_number": "217-359-8022"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAIRFIELD",
"first_name": "MITZIE",
"middle_name": "RALPH",
"name_prefix": "Ms.",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-30",
"last_updated": "2008-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "363LW0102X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Women's Health",
"state": "IL",
"license": "209-000689",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Champaign, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.