Organization Active NPI

Geriatric Care NP Associates

  • Adult Health Nurse Practitioner
  • Bannockburn, IL
National Provider Identifier
1104515121
Registry record updated May 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
Legal business name
GERIATRIC CARE NP ASSOCIATES
Practice address
2515 Waukegan Rd
PMB 10002
Bannockburn, IL 60015
Phone
(847) 655-5040
Fax
(484) 218-4920
NPI assigned
May 4, 2023
Last updated
May 4, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2023

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

Authorized official

Name
Brittany Lynn Tobin, NPNPI 1477831550
Title
Owner
Phone
(847) 655-5040

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X NU Primary

Addresses

Primary practice location

2515 Waukegan Rd
PMB 10002
Bannockburn, IL 60015

Mailing address

2515 Waukegan Rd
PMB 10002
Bannockburn, IL 60015
Phone (847) 655-5040

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, FL, WI3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20240409001908 IL Part B Supplier - Clinic/Group Practice 6103264270 Receives reassigned benefits from 2 practitioners
Practice locations: Bannockburn, IL
O20251125001218 FL Part B Supplier - Clinic/Group Practice 6103264270 Receives reassigned benefits from 1 practitioner
Practice locations: St Petersburg, FL
O20260422002057 WI Part B Supplier - Clinic/Group Practice 6103264270 Receives reassigned benefits from 1 practitioner
Practice locations: Oshkosh, WI

National Provider Directory

National Provider Directory

Locations

2515 Waukegan Rd
Bannockburn, IL 60015
Phone (847) 275-5933

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1683158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683158400000",
    "number": "1104515121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2515 WAUKEGAN RD",
            "address_2": "PMB 10002",
            "city": "BANNOCKBURN",
            "state": "IL",
            "postal_code": "60015",
            "telephone_number": "847-655-5040",
            "fax_number": "484-218-4920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2515 WAUKEGAN RD",
            "address_2": "PMB 10002",
            "city": "BANNOCKBURN",
            "state": "IL",
            "postal_code": "60015",
            "telephone_number": "847-655-5040",
            "fax_number": "484-218-4920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GERIATRIC CARE NP ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-04",
        "last_updated": "2023-05-04",
        "certification_date": "2023-05-04",
        "status": "A",
        "authorized_official_last_name": "TOBIN",
        "authorized_official_first_name": "BRITTANY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-655-5040",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bannockburn, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.