Individual provider Active NPI

Mamie Finney, RD

  • Registered Dietitian
  • Bolingbrook, IL
National Provider Identifier
1174811954
Registry record updated Jul 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
164.001818 Issued in IL
Practice address
125 Maplewood Dr
Bolingbrook, IL 60440-2824
Phone
(630) 378-4402
NPI assigned
Jul 14, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 14, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 164.001818 IL Primary

Addresses

Primary practice location

125 Maplewood Dr
Bolingbrook, IL 60440-2824

Mailing address

125 Maplewood Dr
Bolingbrook, IL 60440-2824

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040202000274 IL Practitioner - Registered Dietitian Or Nutrition Professional 2961305354 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
164.001818ILMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Ad Medical Supply, Inc. Dietitian, Registered CurrentSince Jul 19, 2011 Accepting new patients

Locations

6160 N Cicero Ave
Ste 503
Chicago, IL 60646
Phone (773) 292-1940

Organizations & group practices 1

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": "1310601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1310601600000",
    "number": "1174811954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 MAPLEWOOD DR",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604402824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 MAPLEWOOD DR",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604402824",
            "telephone_number": "630-378-4402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FINNEY",
        "first_name": "MAMIE",
        "credential": "RD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-07-14",
        "last_updated": "2011-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": "164.001818",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bolingbrook, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.