NPIMap

Individual provider Active NPI

Corey Wendell Shumate, APN, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Chicago, IL
National Provider Identifier
1245758580
Registry record updated Jul 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
209.016033 Issued in IL
Practice address
2701 W 68TH St
Chicago, IL 60629
Phone
(773) 884-9000
NPI assigned
Sep 7, 2017
Last updated
Jul 9, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 209.016033 IL Primary

Addresses

Primary practice location

2701 W 68TH St
Chicago, IL 60629

Mailing address

2701 W 68TH St
Chicago, IL 60629-1882
Phone (773) 884-7640

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171024000582 IL Practitioner - Nurse Practitioner 5991071714 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ear to Ear Behavioral Health SolutionsGroup PAC ID 3274922018, 3 clinicians
Saint Anthony Health AffiliatesGroup PAC ID 1254321474, 95 clinicians

Practice addresses (Care Compare)

201 W Lake St
Chicago, IL 60606-0239
Phone (708) 208-4651

2875 W 19TH St
Chicago, IL 60623-3501
Phone (773) 484-4425

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209.016033ILMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Anthony Health Affiliates CurrentSince Apr 6, 2024 Accepting new patients
Mount Sinai Community Foundation Current Accepting new patients
Ear to Ear Behavioral Health Solutions CurrentSince Jan 1, 2021 Accepting new patients
Mount Sinai Community Foundation CurrentSince Sep 1, 2017 Accepting new patients
Saint Anthony Health Affiliates Psychiatric/Mental Health CurrentSince Apr 6, 2024 Accepting new patients
Mount Sinai Community Foundation CurrentSince Sep 1, 2017 Accepting new patients
Saint Anthony Health Affiliates Psychiatric/Mental Health Past Accepting new patients

Locations

201 W Lake St
Chicago, IL 60606
Phone (708) 208-4651

26460 Network Pl
Chicago, IL 60673
Phone (708) 786-2900

2701 W 68th St
Chicago, IL 60629
Phone (773) 471-8000

2875 W 19th St
Chicago, IL 60623
Phone (773) 484-4300

4177 S Archer Ave
Chicago, IL 60632
Phone (773) 254-2222

Organizations & group practices 7

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.

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1504742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531094400000",
    "number": "1245758580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2701 W 68TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606291882",
            "telephone_number": "773-884-7640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2701 W 68TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60629",
            "telephone_number": "773-884-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUMATE",
        "first_name": "COREY",
        "middle_name": "WENDELL",
        "name_prefix": "Mr.",
        "credential": "APN, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-07",
        "last_updated": "2018-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "209.016033",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.