Charlotte Fay Douglas, NP
Individual provider Active NPI Family Nurse Practitioner · Watseka, IL
NPI 1073941670 · NPPES record last updated Oct 17, 2013
Key facts
- NPI
- 1073941670
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 209.010801 (IL)
- Practice address
- 200 E Walnut St
Watseka, IL 60970-1356 - Phone
- (815) 432-3507
- NPI assigned
- Oct 17, 2013
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 11
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- CH Specialty Services Il PLLC
CMC Healthcare LLC
Practice addresses (Care Compare)
111 W Jackson Blvd
Suite 1700
Chicago, IL 60604-3597
Phone (337) 991-9276
1190 E 2900 Horth Rd
Clinton, IL 60927-7103
Phone (815) 694-2306
Hospital & facility affiliations
- Riverside Medical Center
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 |
|---|---|---|---|---|
| I20140512001799 | IL | Practitioner - Nurse Practitioner | 3577796820 | Reassigns benefits to 8 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209.010801 | IL | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Altea Medical Illinois PLLC | Current |
Accepting new patients | |
| 24 On Physicians, P.C. | Current |
Accepting new patients | |
| Parkway Medical Care Il PLLC | Current |
Accepting new patients | |
| CMC Healthcare LLC | Current |
Accepting new patients | |
| Post Acute Medical PLLC | Current |
Accepting new patients | |
| Paragon Clinical LLC | Family | Current |
Accepting new patients |
| 24 On Physicians, PC | Current |
Accepting new patients | |
| Paragon Clinical Midwest, LLC | Past | Accepting new patients | |
| Gibson Community Hospital Association | Past | Accepting new patients |
Locations
400 E Rivulon Blvd
Ste 103
Gilbert, AZ 85297
1333 Burr Ridge Pkwy
Ste 200
Burr Ridge, IL 60527
Phone (630) 308-8706
111 W Jackson Blvd
Ste 1700
Chicago, IL 60604
Phone (708) 223-8405
2451 W Touhy Ave
Chicago, IL 60645
Phone (312) 593-5599
490 W 16th Pl
Chicago Hts, IL 60411
Phone (708) 481-4444
1190 E 2900 North Rd
Clifton, IL 60927
Phone (815) 326-5792
3354 Jerome Ln
East Saint Louis, IL 62206
Phone (618) 337-9400
2201 Main St
Evanston, IL 60202
Phone (847) 905-3000
1101 E State St
Geneva, IL 60134
Phone (630) 208-1876
1100 E Norris Dr
Ottawa, IL 61350
Phone (815) 416-1224
3700 Oakton St
Skokie, IL 60076
Phone (214) 674-4699
555 W Carpenter St
Springfield, IL 62702
Phone (217) 525-1880
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 209.010801 | IL | Yes |
Addresses
Primary practice location
200 E Walnut St
Watseka, IL 60970-1356
Mailing address
200 E Walnut St
Watseka, IL 60970-1356
Phone (815) 432-3507
Other providers in Watseka, IL
- Dara De Boer
- Erin Renae Dean
- Jenny Denault
- Vijay Desai
- Hollye Dionne
- Randy Gene Dowdell
- DRS. Martin & Rose
- Dsi Watseka Operator LLC
- Rebecca Eimer
- Daniel Ellis
All providers in Watseka, 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 Oct 17, 2013. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.