Active NPI
Theresa Ibeabuchi, NURSE PRACTITIONER
- Family Medicine Physician
- Calumet City, IL
National Provider Identifier
1073810271
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 309005064209006414
- Practice address
- 1473 Ring Rd
Calumet City, IL 60409-5459 - Phone
- (708) 862-8156
- NPI assigned
- Feb 24, 2011
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 309005064209006414 | IL | Primary |
Addresses
Primary practice location
1473 Ring Rd
Calumet City, IL 60409-5459
Mailing address
1473 Ring Rd
Calumet City, IL 60409-5459
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
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 309005064209006414 | IL | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Great Heights Family Medicine LTD. | 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.
-
- Addiction Medicine (Family Medicine) Physician
- Calumet City, IL
- NPI 1285854067
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1298505600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1298505600000",
"number": "1073810271",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1473 RING RD",
"city": "CALUMET CITY",
"state": "IL",
"postal_code": "604095459"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1473 RING RD",
"city": "CALUMET CITY",
"state": "IL",
"postal_code": "604095459",
"telephone_number": "708-862-8156"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IBEABUCHI",
"first_name": "THERESA",
"credential": "NURSE PRACTITIONER",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-02-24",
"last_updated": "2011-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "309005064209006414",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Calumet City, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.