Ambili Mariam Jacob

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

209.030952 Issued in IL

Practice address

22285 N Pepper Rd Ste 409
Lake Barrington, IL 60010-2542

Phone

(847) 382-7165

NPI assigned

Sep 9, 2024

Last updated

May 16, 2025By the provider in NPPES

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

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

George N Atia MD SCGroup PAC ID 2961506670, 12 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Advocate Good Shepherd Hospital Hospital, Barrington, IL, CCN 140291
• Advocate Sherman Hospital Hospital, Elgin, IL, CCN 140030
• Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242

Medicare enrollment (NPD)

Enrolled

Credentials

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.

• George N Atia, M.D., S.C.

  dba The Illinois Center for Digestive and Liver health

  • Gastroenterology Physician
  • Barrington, IL
  • NPI 1730214271
  Medicare reassignment Care Compare group NPD
• Windy City Anesthesia PC

  • Certified Registered Nurse Anesthetist
  • Wentzville, MO
  • NPI 1447514377
  NPD (past)

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

• Advocate Health and Hospitals Corporation

  dba Advocate Good Shepherd Hospital

  • General Acute Care Hospital
  • Barrington, IL
  • NPI 1447368071
  Care Compare affiliation
• Advocate Sherman Hospital

  • General Acute Care Hospital
  • Elgin, IL
  • NPI 1629026364
  Care Compare affiliation
• 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
• Sherman Hospital

  • Skilled Nursing Facility
  • Elgin, IL
  • NPI 1275584302

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1725840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747353600000",
    "number": "1275369126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22285 N PEPPER RD STE 409",
            "city": "LAKE BARRINGTON",
            "state": "IL",
            "postal_code": "600102542",
            "telephone_number": "847-382-7165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22285 N PEPPER RD STE 409",
            "city": "LAKE BARRINGTON",
            "state": "IL",
            "postal_code": "600102542",
            "telephone_number": "847-382-7165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "AMBILI",
        "middle_name": "MARIAM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-09",
        "last_updated": "2025-05-16",
        "certification_date": "2025-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209.030952",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041410871",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Il Vein Specialists, LTD.
• Shahid B. Ilahi, M.D.
• Illinois Bone and Joint Institute, LLC
• Illinois Bone and Joint Institute, LLC
• Lisa R. Jackson, N.P.
• Jill S Jacobek, R.PH.
• William Joseph Jedlicka, PHD
• Carolyn Lee Johnson, WHNP, APN
• Karen R Glay (Suburban Hearing Services)
• George Katsamakis, M.D.

• Nurse Practitioner in Lake Barrington, IL
• Providers in Lake Barrington, IL by specialty
• Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2025; 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.