Judith Mongoum Pene, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209.020328 Issued in IL

Practice address

1305 Randall Rd
Crystal Lake, IL 60014-8601

Phone

(815) 386-0386

NPI assigned

Dec 13, 2019

Sex

Female

Sole proprietor

No

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

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

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Minuteclinic Primary Care Illinois PLLCGroup PAC ID 7416471842, 102 clinicians

Minuteclinic Diagnostic of Illinois PLLCGroup PAC ID 8729171566, 106 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H5989

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/683/brand/4/csg/61/fhir/r4

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.

• Minuteclinic Diagnostic of Illinois PLLC

  • Family Nurse Practitioner
  • Mokena, IL
  • NPI 1356485809
  Medicare reassignment Care Compare group NPD
• Minuteclinic Primary Care Illinois PLLC

  • Family Nurse Practitioner
  • Mokena, IL
  • NPI 1528875564
  Medicare reassignment Care Compare group NPD
• Chicago Medical Group, Inc.

  • Multi-Specialty Clinic/Center
  • Orland Park, IL
  • NPI 1285972505
  Medicare reassignment NPD
• Minuteclinic Video Virtual Care North, LLC

  • Family Nurse Practitioner
  • Mokena, IL
  • NPI 1518512227
  Medicare reassignment NPD
• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  IL

  Medicare reassignment NPD

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

{
    "created_epoch": "1576195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685491200000",
    "number": "1134767759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1305 RANDALL RD",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600148601",
            "telephone_number": "815-356-0386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 RANDALL RD",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600148601",
            "telephone_number": "815-386-0386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONGOUM PENE",
        "first_name": "JUDITH",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-13",
        "last_updated": "2023-05-31",
        "certification_date": "2023-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.020328",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mobile Enrichment Services, LLC
• Nicole Elizabeth Mogged, PHARMD
• Irfan K Moinuddin, M.D.
• Momme Wellness LLC
• Alan Joseph Mongin
• Tara M Monica
• Kristin Leona Monical, OTD
• Sandra Terese Montalvo, LCPC
• Mooney Group
• Isaiah Di'Jon Moore

• Family Nurse Practitioner in Crystal Lake, IL
• Providers in Crystal Lake, 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 May 31, 2023; 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.