Bukola Eunice Adeagbo
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Chicago, IL
NPI 1124670948 · NPPES record last updated Apr 14, 2025
Key facts
- NPI
- 1124670948
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 209019375 (IL)
- Practice address
- 850 W Irving Park Rd
Chicago, IL 60613-3077 - Phone
- (773) 975-6775
- NPI assigned
- Jul 11, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- J C Medical Group LTD
Practice addresses (Care Compare)
1635 E 154TH St
Dolton, IL 60419-3001
Phone (708) 841-9550
5025 N Paulina St
Chicago, IL 60640-2772
Phone (773) 271-9040
8012 S Crandon Ave
Chicago, IL 60617-1124
Phone (773) 356-5000
850 W Irving Park Rd
Chicago, IL 60613-3099
Phone (773) 525-6780
Hospital & facility affiliations
- Methodist Hospital of Chicago
- Thorek Memorial Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20191118001455 | IL | Practitioner - Nurse Practitioner | 0840622577 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Beloved Community Family Wellness Center | Current |
Accepting new patients | |
| Beloved Community Family Wellness Center | Current |
Accepting new patients | |
| Marelz, LLC | Psychiatric/Mental Health | Current | Accepting new patients |
| Grow Healthcare Group PA | Psychiatric/Mental Health | Current |
Accepting new patients |
| J C Medical Group LTD | Current |
Accepting new patients |
Locations
6033 N Sheridan Rd
Ste N6
Chicago, IL 60660
Phone (773) 275-4800
326 W 64th St
Ste 205
Chicago, IL 60621
Phone (773) 651-3629
605 N Michigan Ave
Fl 4
Chicago, IL 60611
Phone (773) 232-5338
8201 S Ashland Ave
Chicago, IL 60620
Phone (773) 873-3434
6821 S Halsted St
Chicago, IL 60621
Phone (773) 651-3629
1635 E 154th St
Dolton, IL 60419
Phone (708) 841-9550
Interoperability endpoints
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 209019375 | IL | Yes |
Addresses
Primary practice location
850 W Irving Park Rd
Chicago, IL 60613-3077
Mailing address
850 W Irving Park Rd
Chicago, IL 60613-3077
Phone (773) 975-6775
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 209019375 | Other | IL | MEDICAL LICENSE |
Other providers in Chicago, IL
- Craig Addison
- Sandra L. Addison
- Hannah Addom-Tetteh
- Addus Healthcare Inc
- Addus Healthcare Inc
- Julianne I Adebayo Adegoriolu
- Albert Olugbenga Adebayo
- Favour O Adebayo
- Loni Nicol Adebayo
- Mujidat M Adebayo
All providers in Chicago, IL · Psychiatric/Mental Health Nurse Practitioner in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 14, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.