Individual provider Active NPI

Nicole Fitzgerald, FNP-BC

  • Nurse Practitioner
  • Mokena, IL
National Provider Identifier
1174012454
Registry record updated Oct 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209017551 Issued in IL
Practice address
21202 Owens Rd Ste 101
Mokena, IL 60448-2001
Phone
(779) 334-0030
Fax
(779) 334-0031
NPI assigned
May 2, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209017551 IL
Nurse Practitioner 363L00000X 209017551 IL Primary

Addresses

Primary practice location

21202 Owens Rd Ste 101
Mokena, IL 60448-2001

Mailing address

21202 Owens Rd Ste 101
Mokena, IL 60448-2001
Phone (779) 334-0030

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
I20190722002612 IL Practitioner - Nurse Practitioner 8123354651 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)

15300 W Ave
Orland Park, IL 60462-4600

21202 Owens Rd
Suite 101
Mokena, IL 60448-2001
Phone (630) 315-6930

660 N Westmoreland Rd
302 Lake Forest OBGYN
Lake Forest, IL 60045-1673
Phone (312) 926-6146

675 N Saint Clair St
Chicago, IL 60611-5975

675 N St Clair
Chicago, IL 60611-5975

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.19 of 100Reported as apm
Quality
83.05
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209017551ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince Aug 1, 2021 Accepting new patients
Midwest Express Care 2, Inc CurrentSince Jul 1, 2019 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Aug 1, 2021 Accepting new patients
Midwest Express Care 2, Inc CurrentSince Jul 1, 2019 Accepting new patients

Locations

12200 Western Ave
Blue Island, IL 60406
Phone (630) 581-5372

2070 N State Route 50
Ste 500
Bourbonnais, IL 60914
Phone (779) 236-4094

Dept 5777
Carol Stream, IL 60122

Carol Stream, IL 60122
Phone (630) 933-3300

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

21202 Owens Rd
Ste 101
Mokena, IL 60448
Phone (779) 334-0030

515 Valley View Dr
Ste 201
Moline, IL 61265
Phone (312) 695-0870

7343 Lake St
River Forest, IL 60305
Phone (708) 231-8908

40 75th St
Willowbrook, IL 60527
Phone (630) 326-5312

Organizations & group practices 4

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.

Hospital & facility affiliations 4

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": "1525219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635206400000",
    "number": "1174012454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21202 OWENS RD STE 101",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604482001",
            "telephone_number": "779-334-0030",
            "fax_number": "779-334-0031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21202 OWENS RD STE 101",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604482001",
            "telephone_number": "779-334-0030",
            "fax_number": "779-334-0031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FITZGERALD",
        "first_name": "NICOLE",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-02",
        "last_updated": "2021-10-26",
        "certification_date": "2021-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209017551",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209017551",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mokena, IL

Sources for this page

Verify at the official NPI Registry.