Individual provider Active NPI

Susie Annette Gonzalez-Lazarevic, APRN

  • Family Nurse Practitioner
  • Gurnee, IL
National Provider Identifier
1245847656
Registry record updated Mar 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209022037 Issued in IL
Practice address
1425 N Hunt Club Rd Ste 100
Gurnee, IL 60031-2632
Phone
(847) 548-2200
Fax
(847) 548-2865
NPI assigned
Sep 29, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209022037 IL Primary

Addresses

Primary practice location

1425 N Hunt Club Rd Ste 100
Gurnee, IL 60031-2632

Mailing address

1425 N Hunt Club Rd Ste 100
Gurnee, IL 60031-2632
Phone (847) 548-2200

Other names 1

  • Susie Annette Gonzalez Other name

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
I20210304001369 IL Practitioner - Nurse Practitioner 9537575279 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physicians Immediate Care North Chicago LLCGroup PAC ID 8729064159, 256 clinicians

Practice addresses (Care Compare)

4900 N Cumberland Ave
Norridge, IL 60706-2901
Phone (708) 456-1600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209022037ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Physicians Immediate Care North Chicago LLC CurrentSince Jan 9, 2023 Accepting new patients

Locations

4211 N Cicero Ave
Chicago, IL 60641
Phone (773) 794-1000

13448 Cicero Ave
Crestwood, IL 60418
Phone (708) 682-3384

4460 N Harlem Ave
Norridge, IL 60706
Phone (708) 402-9140

4900 N Cumberland Ave
Norridge, IL 60706
Phone (312) 456-1600

3475 S Alpine Rd
Rockford, IL 61109
Phone (815) 874-8000

534 Randall Rd
South Elgin, IL 60177

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": "1601337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677628800000",
    "number": "1245847656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1425 N HUNT CLUB RD STE 100",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600312632",
            "telephone_number": "847-548-2200",
            "fax_number": "847-548-2865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 N HUNT CLUB RD STE 100",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600312632",
            "telephone_number": "847-548-2200",
            "fax_number": "847-548-2865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ-LAZAREVIC",
        "first_name": "SUSIE",
        "middle_name": "ANNETTE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-29",
        "last_updated": "2023-03-01",
        "certification_date": "2023-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209022037",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSIE",
            "last_name": "GONZALEZ",
            "middle_name": "ANNETTE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Gurnee, IL

Sources for this page

Verify at the official NPI Registry.