Individual provider Active NPI

Mauricio Valencia

  • Family Nurse Practitioner
  • Park Ridge, IL
National Provider Identifier
1134636228
Registry record updated Dec 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209.017085 Issued in IL
Practice address
850 Busse Hwy
Park Ridge, IL 60068-2302
Phone
(847) 759-4770
Fax
(847) 759-8824
NPI assigned
Jan 10, 2018
Last updated
Dec 16, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2022

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 10933 WI
Family Nurse Practitioner 363LF0000X 209.017085 IL Primary

Addresses

Primary practice location

850 Busse Hwy
Park Ridge, IL 60068-2302

Mailing address

29373 Network PL
Chicago, IL 60673-1293
Phone (847) 390-5900

Other practice location 1

2520 Elisha Ave
Zion, IL 60099-2676
Phone (847) 872-6380

Other practice location 2

10400 75th St
Kenosha, WI 53142-7884
Phone (262) 948-5600

Other identifiers 1

IdentifierTypeStateIssuer
100170179MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mvalencia312205@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

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
I20180406000479 IL Practitioner - Nurse Practitioner 2567725492 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

214 McHenry Rd
Buffalo Grove, IL 60089-6748
Phone (847) 459-1160

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10933WIMDPhysical Therapist
209.017085ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
City of Hope Medical Group of Illinois PLLC CurrentSince Jan 16, 2018 Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Nov 18, 2022 Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Nov 18, 2022 Accepting new patients

Locations

214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160

2361 Paysphere Cir
Chicago, IL 60674
Phone (847) 746-4358

29373 Network Pl
Chicago, IL 60673

850 Busse Hwy
Park Ridge, IL 60068
Phone (847) 384-8511

2520 Elisha Ave
Zion, IL 60099
Phone (800) 322-9183

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1515542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671148800000",
    "number": "1134636228",
    "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",
            "fax_number": "847-390-4757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 BUSSE HWY",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600682302",
            "telephone_number": "847-759-4770",
            "fax_number": "847-759-8824"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2520 Elisha Ave",
            "address_purpose": "LOCATION",
            "city": "Zion",
            "state": "IL",
            "postal_code": "600992676",
            "country_code": "US",
            "telephone_number": "847-872-6380",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10400 75th St",
            "address_purpose": "LOCATION",
            "city": "Kenosha",
            "state": "WI",
            "postal_code": "531427884",
            "country_code": "US",
            "telephone_number": "262-948-5600",
            "fax_number": "262-948-5735",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VALENCIA",
        "first_name": "MAURICIO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-01-10",
        "last_updated": "2022-12-16",
        "certification_date": "2022-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "10933",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.017085",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100170179",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mvalencia312205@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "850 Busse Hwy",
            "city": "Park Ridge",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600682302",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "850 Busse Hwy",
            "city": "Park Ridge",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600682302",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Park Ridge, IL

Sources for this page

Verify at the official NPI Registry.