Individual provider Active NPI

Ella Cecilia Heras

  • Primary Care Nurse Practitioner
  • Chicago, IL
National Provider Identifier
1205217312
Registry record updated Jul 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
209.012808 Issued in IL
Practice address
6821 S Halsted St
Chicago, IL 60621-1833
Phone
(773) 651-3629
NPI assigned
Jun 15, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X 209.012808 IL Primary

Addresses

Primary practice location

6821 S Halsted St
Chicago, IL 60621-1833

Mailing address

6821 S Halsted St
Chicago, IL 60621-1833
Phone (773) 651-3629

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
I20150914002891 IL Practitioner - Nurse Practitioner 5294042859 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209.012808ILMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Beloved Community Family Wellness Center CurrentSince Oct 25, 2015 Accepting new patients
Beloved Community Family Wellness Center CurrentSince Oct 25, 2015 Accepting new patients

Locations

326 W 64th St
Ste 205
Chicago, IL 60621
Phone (773) 651-3629

6821 S Halsted St
Chicago, IL 60621
Phone (773) 651-3629

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: ella.heras.p21@direct.fhn-fqhc.nextgenshare.com

Organizations & group practices 2

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": "1434326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435795200000",
    "number": "1205217312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6821 S HALSTED ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606211833",
            "telephone_number": "773-651-3629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6821 S HALSTED ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606211833",
            "telephone_number": "773-651-3629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERAS",
        "first_name": "ELLA CECILIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-15",
        "last_updated": "2015-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "IL",
            "license": "209.012808",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.