Tara Dedic Henrikson, APN

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

209.009963 Issued in IL

Practice address

250 E Superior St Ste 4-420
Chicago, IL 60611-2914

Phone

(312) 695-0990

Fax

(312) 472-4784

NPI assigned

Aug 21, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

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

Specialty

Nurse Practitioner

Education

Loyola University of Chicago, Stritch School of Medicine, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Northwestern Medical Faculty FoundationGroup PAC ID 4587576814, 4,386 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northwestern Memorial Hospital Hospital, Chicago, IL, CCN 140281
• Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242
• Palos Community Hospital Hospital, Palos Heights, IL, CCN 140062
• Northwestern Lake Forest Hospital Hospital, Lake Forest, IL, CCN 140130

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northwestern Medical Faculty Foundation

  dba Northwestern Medical Group

  • Multi-Specialty Clinic/Center
  • Carol Stream, IL
  • NPI 1346235314
  Medicare reassignment Care Compare group NPD
• Northwestern Medical Faculty Foundation

  dba Northwestern Medical Group

  • Durable Medical Equipment & Medical Supplies
  • Chicago, IL
  • NPI 1417718479
  NPD
• Central Dupage Physician Group

  dba Northwestern Medicine Regional Medical Group

  • Family Medicine Physician
  • Carol Stream, IL
  • NPI 1033149844
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Central Dupage Hospital Association

  dba Northwestern Medicine Central Dupage Hospital

  • General Acute Care Hospital
  • Winfield, IL
  • NPI 1003864810
  Care Compare affiliation
• Central Dupage Hospital Association

  dba Northwestern Medicine Central Dupage Hospital

  • Psychiatric Hospital Unit
  • Winfield, IL
  • NPI 1740230895
  Care Compare affiliation
• Northwestern Lake Forest Hospital

  dba Northwestern Medicine Lake Forest Hospital

  • General Acute Care Hospital
  • Lake Forest, IL
  • NPI 1124025176
  Care Compare affiliation
• Northwestern Memorial Hospital

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1497859649
  Care Compare affiliation
• Palos Community Hospital

  • Psychiatric Hospital Unit
  • Palos Heights, IL
  • NPI 1184699118
  Care Compare affiliation
• Palos Community Hospital

  • General Acute Care Hospital
  • Palos Heights, IL
  • NPI 1851386692
  Care Compare affiliation

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

{
    "created_epoch": "1345507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568764800000",
    "number": "1225386345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2160 SOUTH 1ST AVENUE",
            "city": "MAYOOWD",
            "state": "IL",
            "postal_code": "60153",
            "telephone_number": "708-216-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 E SUPERIOR ST STE 4-420",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112914",
            "telephone_number": "312-695-0990",
            "fax_number": "312-472-4784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENRIKSON",
        "first_name": "TARA",
        "middle_name": "DEDIC",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-21",
        "last_updated": "2019-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WX0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Oncology",
            "state": "IL",
            "license": "041347688",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209009963",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IL",
            "license": "209.009963",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robin Henrard, PT
• Masen C Henretta, LSW
• Kanchana Henrich
• Ulf Rikard Henricsson, D.N. NAPRAPATH
• Kammi Henriksen
• Jane Elizabeth Henriques, MD
• Matthew Edwin Henriques, MD
• Silvia Henriquez Gerken
• David Omar Henriquez Ticas, M.D.
• Henry Booth House

• Adult Health Nurse Practitioner in Chicago, IL
• Providers in Chicago, IL by specialty
• Adult Health Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.