Charlotte Fay Douglas, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209.010801 Issued in IL

Practice address

200 E Walnut St
Watseka, IL 60970-1356

Phone

(815) 432-3507

NPI assigned

Oct 17, 2013

Last updated

Oct 17, 2013By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

CH Specialty Services Il PLLCGroup PAC ID 8224402482, 20 clinicians

CMC Healthcare LLCGroup PAC ID 4688039209, 133 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Riverside Medical Center Hospital, Kankakee, IL, CCN 140186

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• CMC Healthcare LLC

  • Nurse Practitioner
  • Evanston, IL
  • NPI 1295432334
  Medicare reassignment Care Compare group NPD
• CH Specialty Services Il PLLC

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1922707702
  Medicare reassignment Care Compare group
• 24 On Physicians, PC

  • Hospitalist Physician
  • Ottawa, IL
  • NPI 1346480431
  Medicare reassignment NPD
• Altea Medical Illinois PLLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Chicago Heights, IL
  • NPI 1447039227
  Medicare reassignment NPD
• Paragon Clinical LLC

  • Nurse Practitioner
  • Burr Ridge, IL
  • NPI 1114139946

  Family

  Medicare reassignment NPD
• Parkway Medical Care Il PLLC

  • Multi-Specialty Clinic/Center
  • Skokie, IL
  • NPI 1639968712
  Medicare reassignment NPD
• Post Acute Medical PLLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Lanham, MD
  • NPI 1730713025

  IL

  Medicare reassignment NPD
• Curana Health of Illinois PC

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1891400156
  Medicare reassignment
• 24 On Physicians, P.C.

  • Hospitalist Physician
  • Attleboro, MA
  • NPI 1790104511
  NPD
• Gibson Community Hospital Association

  dba Gibson Area Hospital and Health Services

  • Critical Access Hospital
  • Gibson City, IL
  • NPI 1114935681
  NPD (past)
• Paragon Clinical Midwest, LLC

  • Nurse Practitioner
  • Merrillville, IN
  • NPI 1619335700
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Riverside Medical Center

  • General Acute Care Hospital
  • Kankakee, IL
  • NPI 1538208210
  Care Compare affiliation

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

{
    "created_epoch": "1381968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381968000000",
    "number": "1073941670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E WALNUT ST",
            "city": "WATSEKA",
            "state": "IL",
            "postal_code": "609701356",
            "telephone_number": "815-432-3507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 E WALNUT ST",
            "city": "WATSEKA",
            "state": "IL",
            "postal_code": "609701356",
            "telephone_number": "815-432-3507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "CHARLOTTE",
        "middle_name": "FAY",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-10-17",
        "last_updated": "2013-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.010801",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dara De Boer, ATC
• Erin Renae Dean, FNP-BC
• Jenny Denault
• Vijay Desai, M.D.
• Hollye Dionne
• Randy Gene Dowdell, M.A.
• DRS. Martin & Rose
• Dsi Watseka Operator LLC (Heritage Woods of Watseka)
• Rebecca Eimer
• Daniel Ellis

• Family Nurse Practitioner in Watseka, IL
• Providers in Watseka, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.