Individual provider Active NPI

Ariana Sandoval, APRN

  • Family Nurse Practitioner
  • Berwyn, IL
National Provider Identifier
1275155764
Registry record updated Jul 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209.020936 Issued in IL
Practice address
6447 Cermak Rd
Berwyn, IL 60402-2311
Phone
(773) 254-1400
NPI assigned
May 7, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 4, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209.020936 IL Primary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 209.020936 IL

Addresses

Primary practice location

6447 Cermak Rd
Berwyn, IL 60402-2311

Mailing address

153 Cedarwood Ave
Bolingbrook, IL 60440-3005
Phone (708) 769-0234

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
I20200717002316 IL Practitioner - Nurse Practitioner 5496915431 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
Alivio Medical Center, Inc.Group PAC ID 5698840924, 23 clinicians

Practice addresses (Care Compare)

6447 Cermak Rd
Berwyn, IL 60402-2311
Phone (773) 254-1400

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209.020936ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Gateway Professional Services, PC CurrentSince Apr 17, 2023 Accepting new patients
Alivio Medical Center, Inc. CurrentSince May 11, 2020 Accepting new patients
Gateway Professional Services, PC Current Accepting new patients
Alivio Medical Center, Inc. CurrentSince May 11, 2020 Accepting new patients
Alivio Medical Center, Inc. Current Accepting new patients
Gateway Professional Services, PC CurrentSince Apr 17, 2023 Accepting new patients

Locations

400 Mercy Ln
Aurora, IL 60506
Phone (630) 966-7400

6447 Cermak Rd
Berwyn, IL 60402
Phone (773) 254-1400

1080 E Park St
Carbondale, IL 62901
Phone (618) 529-1151

966 W 21st St
Chicago, IL 60608
Phone (773) 254-1400

2355 S Western Ave
Chicago, IL 60608
Phone (773) 254-1400

Organizations & group practices 6

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": "1588809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688428800000",
    "number": "1275155764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "153 CEDARWOOD AVE",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604403005",
            "telephone_number": "708-769-0234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6447 CERMAK RD",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604022311",
            "telephone_number": "773-254-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDOVAL",
        "first_name": "ARIANA",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-07",
        "last_updated": "2023-07-04",
        "certification_date": "2023-07-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.020936",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "209.020936",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berwyn, IL

Sources for this page

Verify at the official NPI Registry.