Premium Practitioners Plus Inc.

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

PREMIUM PRACTITIONERS PLUS INC.

Practice address

19801 Governors Hwy Ste 140
Flossmoor, IL 60422-4363

Phone

(708) 635-6484

Fax

(312) 585-5620

NPI assigned

Dec 11, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Talia Thompson- Jones, FPA APRN, DNP

Title

FNP-BC

Phone

(708) 991-2945

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

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

{
    "created_epoch": "1544486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670371200000",
    "number": "1194296533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5331 STANFORD LN",
            "city": "MATTESON",
            "state": "IL",
            "postal_code": "604431671",
            "telephone_number": "708-600-0965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19801 GOVERNORS HWY STE 140",
            "city": "FLOSSMOOR",
            "state": "IL",
            "postal_code": "604224363",
            "telephone_number": "708-635-6484",
            "fax_number": "312-585-5620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIUM PRACTITIONERS PLUS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-11",
        "last_updated": "2022-12-07",
        "certification_date": "2022-12-07",
        "status": "A",
        "authorized_official_last_name": "THOMPSON- JONES",
        "authorized_official_first_name": "TALIA",
        "authorized_official_title_or_position": "FNP-BC",
        "authorized_official_telephone_number": "708-991-2945",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "FPA APRN, DNP"
    },
    "taxonomies": [
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "F400625230",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "INFO@PREMIUMPRACTITIONERS.COM",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "19801 Governors Hwy Ste 140",
            "city": "Flossmoor",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604224363",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Primary Care Clinic/Center in Flossmoor, IL
• Providers in Flossmoor, IL by specialty
• Primary Care Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2022; 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.