Individual provider Active NPI

Bailey Marie Jenkins

  • Nurse Practitioner
  • Chicago, IL
National Provider Identifier
1174306484
Registry record updated May 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209028548 Issued in IL
Practice address
4700 S California Ave
Chicago, IL 60632-2016
Phone
(773) 584-6200
NPI assigned
Aug 18, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2024

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 209028548 IL Primary

Addresses

Primary practice location

4700 S California Ave
Chicago, IL 60632-2016

Mailing address

6500 Wolf Rd
Indian Head Park, IL 60525-4369
Phone (248) 752-7108

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
I20240523001451 IL Practitioner - Nurse Practitioner 8123460011 Reassigns benefits to 1 organization

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
Esperanza Health CentersGroup PAC ID 2961453105, 53 clinicians

Practice addresses (Care Compare)

4720 S California Ave
Chicago, IL 60632-2016
Phone (773) 584-6140

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209028548ILMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Esperanza Health Centers CurrentSince Apr 10, 2024 Accepting new patients
Esperanza Health Centers Current Accepting new patients
Esperanza Health Centers CurrentSince Apr 10, 2024 Accepting new patients
Esperanza Health Centers Past Accepting new patients
Esperanza Health Centers Past Accepting new patients
Esperanza Health Centers Past Accepting new patients

Locations

4700 S California Ave
Chicago, IL 60632
Phone (708) 713-0078

4720 S California Ave
Chicago, IL 60632
Phone (312) 942-2877

2001 S California Ave
Ste 100
Chicago, IL 60608
Phone (773) 640-5785

2001 S California Ave
Chicago, IL 60608
Phone (773) 484-1201

Interoperability endpoints

  • Direct secure messaging: bailey.jenkins.1@11903.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/11903/brand/1/csg/1/fhir/r4

Organizations & group practices 6

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": "1692316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715558400000",
    "number": "1174306484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6500 WOLF RD",
            "city": "INDIAN HEAD PARK",
            "state": "IL",
            "postal_code": "605254369",
            "telephone_number": "248-752-7108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 S CALIFORNIA AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606322016",
            "telephone_number": "773-584-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENKINS",
        "first_name": "BAILEY",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-18",
        "last_updated": "2024-05-13",
        "certification_date": "2024-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209028548",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.