Kaitlyn Jamie Lundgren

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209017501 Issued in IL

Practice address

3220 W Il Route 60
Mundelein, IL 60060-4271

Phone

(847) 837-8442

Fax

(847) 837-8542

NPI assigned

Apr 25, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Kaitlyn Jamie White Former name

Electronic endpoints 2

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

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Advocate Health and Hospitals Corporation

  • Multi-Specialty Clinic/Center
  • Oak Brook, IL
  • NPI 1700824455
  NPD

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

{
    "created_epoch": "1524614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654473600000",
    "number": "1114415205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29373 NETWORK PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606731293",
            "telephone_number": "847-390-5900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3220 W IL ROUTE 60",
            "city": "MUNDELEIN",
            "state": "IL",
            "postal_code": "600604271",
            "telephone_number": "847-837-8442",
            "fax_number": "847-837-8542"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "431 W Liberty St",
            "address_purpose": "LOCATION",
            "city": "Wauconda",
            "state": "IL",
            "postal_code": "60084",
            "country_code": "US",
            "telephone_number": "847-526-2151",
            "fax_number": "847-526-2017",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LUNDGREN",
        "first_name": "KAITLYN",
        "middle_name": "JAMIE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-04-25",
        "last_updated": "2022-06-06",
        "certification_date": "2020-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209017501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "3220 W Il Route 60",
            "city": "Mundelein",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600604271",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "klundgren261739@direct.myadvocateaurora.org",
            "affiliation": "N",
            "address_1": "3220 W Il Route 60",
            "city": "Mundelein",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600604271",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KAITLYN",
            "last_name": "WHITE",
            "middle_name": "JAMIE",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Anthony Richard Markiewicz, DDS

• Family Nurse Practitioner in Mundelein, IL
• Providers in Mundelein, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.