Individual provider Active NPI

Jessica Medina

  • Family Nurse Practitioner
  • Chicago, IL
National Provider Identifier
1104588979
Registry record updated May 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209022090 Issued in IL
Practice address
779 W Adams St
Chicago, IL 60661-3509
Phone
(312) 382-8308
NPI assigned
Oct 9, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209022090 IL Primary

Addresses

Primary practice location

779 W Adams St
Chicago, IL 60661-3509

Mailing address

1323 S 49TH CT
Cicero, IL 60804-1406
Phone (872) 203-1703

Other practice location 1

2233 W Division St
Chicago, IL 60622-8151
Phone (312) 770-2000

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20250310000359 IL Practitioner - Nurse Practitioner 8729509559 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Midwest Express Care 2, IncGroup PAC ID 0547495467, 221 clinicians

Practice addresses (Care Compare)

40 75TH St
Willowbrook, IL 60527-2325
Phone (630) 581-5372

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Cepamerica Illinois LLP CurrentSince Mar 1, 2025 Accepting new patients
Cepamerica Illinois LLP CurrentSince Mar 1, 2025 Accepting new patients
Midwest Express Care 2, Inc CurrentSince Mar 14, 2025 Accepting new patients
Cepamerica Illinois LLP Current Accepting new patients
Midwest Express Care 2, Inc CurrentSince Mar 14, 2025 Accepting new patients

Locations

2100 Powell St
Ste 400
Emeryville, CA 94608
Phone (510) 350-2638

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

3249 Oak Park Ave
Berwyn, IL 60402
Phone (708) 783-2696

779 W Adams St
Chicago, IL 60661
Phone (312) 382-8308

40 75th St
Willowbrook, IL 60527
Phone (630) 326-5312

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1633737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746489600000",
    "number": "1104588979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1323 S 49TH CT",
            "city": "CICERO",
            "state": "IL",
            "postal_code": "608041406",
            "telephone_number": "872-203-1703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "779 W ADAMS ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606613509",
            "telephone_number": "312-382-8308"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2233 W Division St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606228151",
            "country_code": "US",
            "telephone_number": "312-770-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "JESSICA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-09",
        "last_updated": "2025-05-06",
        "certification_date": "2025-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209022090",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.