Individual provider Active NPI

Dhara S Patel, MSN, FNP-BC

  • Nurse Practitioner
  • Aurora, IL
National Provider Identifier
1104647478
Registry record updated Jan 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209029970 Issued in IL
Practice address
4205 Westbrook Dr
Aurora, IL 60504-4124
Phone
(630) 873-8889
NPI assigned
Oct 21, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 209029970 IL Primary
Family Nurse Practitioner 363LF0000X 209029970 IL

Addresses

Primary practice location

4205 Westbrook Dr
Aurora, IL 60504-4124

Mailing address

Pob 7132960
Chicago, IL 60677-0001
Phone (630) 469-9200

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dpatel293914@dulyhealthandcare.direct-ci.com Direct

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
I20241212000444 IL Practitioner - Nurse Practitioner 1759817893 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southside Primary Care Group SCGroup PAC ID 4587952650, 9 clinicians

Practice addresses (Care Compare)

7531 S Stony Island Ave
Chicago, IL 60649-3954
Phone (773) 947-2831

Hospital & facility affiliations

  • Elmhurst Memorial Hospital Hospital, Elmhurst, IL, CCN 140200

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
209029970ILMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Rajiv Kandala M D S C CurrentSince Oct 1, 2025 Accepting new patients
Dupage Medical Group LTD CurrentSince Jan 6, 2025 Accepting new patients
Dupage Medical Group LTD CurrentSince Jan 6, 2025 Accepting new patients
Southside Primary Care Group SC CurrentSince Oct 1, 2025 Accepting new patients
FMGC, S.C. Past Accepting new patients

Locations

4205 Westbrook Dr
Aurora, IL 60504
Phone (630) 527-1818

7531 S Stony Island Ave
#164
Chicago, IL 60649
Phone (773) 947-2831

7531 S Stony Island Ave
Ste 16
Chicago, IL 60649

7531 S Stony Island Ave
Ste 164
Chicago, IL 60649
Phone (773) 947-2831

7531 S Stony Island Ave
Chicago, IL 60649
Phone (773) 947-7310

25 N Winfield Rd
Ste 300
Winfield, IL 60190
Phone (630) 933-8100

Interoperability endpoints

  • Direct secure messaging: dpatel293914@dulyhealthandcare.direct-ci.com

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.

Hospital & facility affiliations 1

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": "1729468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737417600000",
    "number": "1104647478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "POB 7132960",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606770001",
            "telephone_number": "630-469-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4205 WESTBROOK DR",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605044124",
            "telephone_number": "630-873-8889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATEL",
        "first_name": "DHARA",
        "middle_name": "S",
        "credential": "MSN, FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-21",
        "last_updated": "2025-01-21",
        "certification_date": "2025-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209029970",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209029970",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dpatel293914@dulyhealthandcare.direct-ci.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4205 Westbrook Dr",
            "city": "Aurora",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605044124",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Aurora, IL

Sources for this page

Verify at the official NPI Registry.