Individual provider Active NPI

Kawana Fantasia Tharps, DNP, APRN, FNP-C

  • Family Nurse Practitioner
  • Chicago, IL
National Provider Identifier
1154949857
Registry record updated Aug 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209024591 Issued in IL
Practice address
4747 N Kedzie Ave
Chicago, IL 60625-4420
Phone
(312) 666-3494
NPI assigned
Jul 9, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 23, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neonatal Intensive Care Registered Nurse 163WN0002X 041436212 IL
Family Nurse Practitioner 363LF0000X 209024591 IL Primary

Addresses

Primary practice location

4747 N Kedzie Ave
Chicago, IL 60625-4420

Mailing address

4747 N Kedzie Ave
Chicago, IL 60625-4420
Phone (312) 666-3494

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
I20221018002193 IL Practitioner - Nurse Practitioner 2466828371 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Erie Family Health Center, IncGroup PAC ID 9537050422, 141 clinicians

Practice addresses (Care Compare)

1504 S Albany Ave
Chicago, IL 60623-2209
Phone (312) 666-3494

646 N Lawndale Ave
Chicago, IL 60624-1254
Phone (312) 666-3494

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
041436212ILMDNeonatal Intensive Care Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Erie Family Health Center Inc CurrentSince Jul 13, 2022 Accepting new patients
Erie Family Health Center, Inc Current Accepting new patients
Erie Family Health Center Inc CurrentSince Jul 13, 2022 Accepting new patients

Locations

1701 W Superior St
Chicago, IL 60622
Phone (312) 432-7392

1701 W Superior St
Fl 3
Chicago, IL 60622
Phone (312) 432-7381

4747 N Kedzie Ave
Chicago, IL 60625

1504 S Albany Ave
Chicago, IL 60623

Interoperability endpoints

  • Direct secure messaging: ktharps585875@direct.ochin.org

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1594252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661212800000",
    "number": "1154949857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4747 N KEDZIE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606254420",
            "telephone_number": "312-666-3494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4747 N KEDZIE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606254420",
            "telephone_number": "312-666-3494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THARPS",
        "first_name": "KAWANA",
        "middle_name": "FANTASIA",
        "name_prefix": "Miss",
        "credential": "DNP, APRN, FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-09",
        "last_updated": "2022-08-23",
        "certification_date": "2022-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WN0002X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Neonatal Intensive Care",
            "state": "IL",
            "license": "041436212",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209024591",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.