Individual provider Active NPI

Candice Michelle Pielago Aphaivong, FNP-BC

  • Family Nurse Practitioner
  • Elgin, IL
National Provider Identifier
1124503602
Registry record updated Oct 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209018293 Issued in IL
Practice address
370 Summit St
Elgin, IL 60120-3843
Phone
(847) 608-1344
NPI assigned
Oct 1, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 1, 2018

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 209018293 IL Primary

Addresses

Primary practice location

370 Summit St
Elgin, IL 60120-3843

Mailing address

1420 Evergreen LN
Pingree Grove, IL 60140-9103
Phone (773) 600-2005

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
I20201014003657 IL Order and Referring Only - Nurse Practitioner 5092135905

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209018293ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Greater Family Health Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: candice.aphaivong.p1@direct.gefcc.nextgenshare.com

Organizations & group practices 1

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": "1538352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538352000000",
    "number": "1124503602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1420 EVERGREEN LN",
            "city": "PINGREE GROVE",
            "state": "IL",
            "postal_code": "601409103",
            "telephone_number": "773-600-2005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "370 SUMMIT ST",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "601203843",
            "telephone_number": "847-608-1344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "APHAIVONG",
        "first_name": "CANDICE MICHELLE",
        "middle_name": "PIELAGO",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-10-01",
        "last_updated": "2018-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209018293",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elgin, IL

Sources for this page

Verify at the official NPI Registry.