NPIMap

Individual provider Active NPI

Senora Nelson, MD

  • General Practice Physician
  • South Holland, IL
National Provider Identifier
1093855835
Registry record updated Jun 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
036106244 Issued in IL
Practice address
901 E Sibley Blvd
South Holland, IL 60473-1166
Phone
(773) 233-4100
Fax
(773) 233-4055
NPI assigned
Feb 8, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 036106244 IL Primary

Addresses

Primary practice location

901 E Sibley Blvd
South Holland, IL 60473-1166

Mailing address

PO Box 288080
Chicago, IL 60628-8080
Phone (773) 233-4100

Other identifiers 1

IdentifierTypeStateIssuer
036106244MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060110000676 IL Practitioner - Family Practice 0547283152 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Loyola University of Chicago, Stritch School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Advocate Health and Hospitals CorporationGroup PAC ID 7810800935, 3,081 clinicians

Practice addresses (Care Compare)

2301 E 93Rd St
Chicago, IL 60617-3912
Phone (773) 731-9898

Hospital & facility affiliations

  • Advocate Home Health Care Serv Home health agency, Oakbrook, IL, CCN 147150
  • Advocate Trinity Hospital Hospital, Chicago, IL, CCN 140048
  • Advocate Christ Hospital & Medical Center Hospital, Oak Lawn, IL, CCN 140208

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036106244ILMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advocate Health and Hospitals Corporation CurrentSince Jan 1, 2013 Accepting new patients
Advocate Health and Hospitals Corporation Current Accepting new patients
Advocate Health & Hospitals Corporation CurrentSince Jan 1, 2013 Accepting new patients
Emergency Care Physician Services-Blue Island LTD Past Accepting new patients
Sullivan Urgent Aid Centers, LTD Past Accepting new patients
The Board of Trustees of the University of Illinois Past Accepting new patients

Locations

214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160

2545 S Ml King Dr
Chicago, IL 60616
Phone (312) 842-7117

1945 W Wilson Ave
Fl 4
Chicago, IL 60640
Phone (773) 736-6220

29373 Network Pl
Chicago, IL 60673

2301 E 93rd St
Chicago, IL 60617
Phone (773) 731-9898

Interoperability endpoints

  • Direct secure messaging: snelson205976@direct.myadvocateaurora.org

Organizations & group practices 6

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213228800000",
    "number": "1093855835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 288080",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606288080",
            "telephone_number": "773-233-4100",
            "fax_number": "773-233-4055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 E SIBLEY BLVD",
            "city": "SOUTH HOLLAND",
            "state": "IL",
            "postal_code": "604731166",
            "telephone_number": "773-233-4100",
            "fax_number": "773-233-4055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "SENORA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-08",
        "last_updated": "2008-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "IL",
            "license": "036106244",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036106244",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Holland, IL

Sources for this page

Verify at the official NPI Registry.