Individual provider Active NPI

Jennifer Lizen

  • Nurse Practitioner
  • Joliet, IL
National Provider Identifier
1144094822
Registry record updated Nov 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209.028243 Issued in IL
Practice address
819 Campus Dr
Joliet, IL 60435-8573
Phone
(779) 204-5242
NPI assigned
Nov 13, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 13, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 209.028243 IL Primary

Addresses

Primary practice location

819 Campus Dr
Joliet, IL 60435-8573

Mailing address

1536 Edentenny Rd
New Lenox, IL 60451-2947
Phone (773) 573-3558

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
I20240430000401 IL Practitioner - Nurse Practitioner 9638519283 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Integrated Pain Management SCGroup PAC ID 2466427158, 23 clinicians

Practice addresses (Care Compare)

244 E Roosevelt Rd
Lombard, IL 60148-4647
Phone (630) 629-6298

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209.028243ILMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Integrated Pain Management SC CurrentSince Mar 13, 2024 Accepting new patients
Integrated Pain Management, SC CurrentSince May 19, 2024 Accepting new patients
Integrated Pain Management SC CurrentSince Mar 13, 2024 Accepting new patients

Locations

819 Campus Dr
Joliet, IL 60435
Phone (815) 744-0808

244 E Roosevelt Rd
Lombard, IL 60148
Phone (312) 842-4588

Organizations & group practices 5

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": "1699833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699833600000",
    "number": "1144094822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1536 EDENTENNY RD",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "604512947",
            "telephone_number": "773-573-3558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "819 CAMPUS DR",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604358573",
            "telephone_number": "779-204-5242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIZEN",
        "first_name": "JENNIFER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-11-13",
        "last_updated": "2023-11-13",
        "certification_date": "2023-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209.028243",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Joliet, IL

Sources for this page

Verify at the official NPI Registry.