Theodise Harris, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209022572 Issued in IL

Practice address

2003 W Fulton St
Chicago, IL 60612-2345

Phone

(312) 243-2223

NPI assigned

Dec 29, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL, IN2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

MD @ Home Illinois, SCGroup PAC ID 7810167830, 53 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Accentcare Home Health of Illinois Home health agency, Lombard, IL, CCN 147811
• Complete Home Health Services, Inc Home health agency, South Holland, IL, CCN 148219
• Interim Healthcare of Chicago Home health agency, Alsip, IL, CCN 147182
• Medpro Health Providers Home health agency, Tinley Park, IL, CCN 148246
• Astra Health Home health agency, Harwood Heights, IL, CCN 148259
• Northwest Community Hospital 1 Hospital, Arlington Heights, IL, CCN 140252

Merit-based Incentive Payment System (MIPS)

Final score

80.62 of 100Reported as group

Quality

64.25

Promoting interoperability

95

Improvement activities

40

Cost

41.97

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: theodise.harris.1@3342.direct.athenahealth.com

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.

• MD @ Home Illinois, SC

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1568758415

  IN, Multi-Specialty

  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Cardinal Homehealth Inc

  • Home Health Agency
  • Harwood Heights, IL
  • NPI 1518108703
  Care Compare affiliation
• Complete Home Health Services, Inc

  • Home Health Agency
  • South Holland, IL
  • NPI 1245460385
  Care Compare affiliation
• Health Resources Solutions Inc

  • Home Health Agency
  • Lombard, IL
  • NPI 1528094109
  Care Compare affiliation
• Medpro Health Providers LLC

  • Home Health Agency
  • Tinley Park, IL
  • NPI 1073820049
  Care Compare affiliation
• Northwest Community Hospital

  • General Acute Care Hospital
  • Arlington Heights, IL
  • NPI 1578932869
  Care Compare affiliation
• Northwest Community Hospital

  • General Acute Care Hospital
  • Arlington Heights, IL
  • NPI 1770531600
  Care Compare affiliation
• PSG Services, LLC

  • Home Health Agency
  • Alsip, IL
  • NPI 1598725103
  Care Compare affiliation

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

{
    "created_epoch": "1609200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648425600000",
    "number": "1134716830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2003 W FULTON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606122345",
            "telephone_number": "312-243-2223",
            "fax_number": "312-243-2227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2003 W FULTON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606122345",
            "telephone_number": "312-243-2223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "THEODISE",
        "name_prefix": "Mr.",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-12-29",
        "last_updated": "2022-03-28",
        "certification_date": "2021-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209022572",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Satyra Harris
• Sharlise Harris
• Stephanie Harris
• Stephanie Harris
• Tamlin J Harris, PHARMD.
• Valerie Harris
• Vita Kay Harris
• Wanda Harris
• William H Harris Sr.
• Wilma Maxcine Harris, LPN

• Family Nurse Practitioner in Chicago, IL
• Providers in Chicago, 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 Mar 28, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.