Clarisa Medina Poeliniz, APN

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

209.007592 Issued in IL

Practice address

903 S 7TH St Ste C
Rochelle, IL 61068-9375

Phone

(815) 562-6976

Fax

(815) 562-9786

NPI assigned

Jun 23, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• County of Ogle

  • Public Health or Welfare Agency
  • Oregon, IL
  • NPI 1376564039
  NPD (past)

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

{
    "created_epoch": "1245715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359331200000",
    "number": "1285862748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "903 S 7TH ST STE C",
            "city": "ROCHELLE",
            "state": "IL",
            "postal_code": "610689375",
            "telephone_number": "815-562-6976",
            "fax_number": "815-562-9786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 S 7TH ST STE C",
            "city": "ROCHELLE",
            "state": "IL",
            "postal_code": "610689375",
            "telephone_number": "815-562-6976",
            "fax_number": "815-562-9786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA POELINIZ",
        "first_name": "CLARISA",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-23",
        "last_updated": "2013-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041.317970",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IL",
            "license": "209.007592",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "376793031",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "376796015",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amie McDermott, LMT
• Daniel McDermott
• Jennifer McGee, LMT
• Leanna Ruth McMeekan
• Medcare Health Center LTD
• Dana Meyers, L.M.T.
• Kourtnee Jo Mezo
• Michael J. Monfils, M.D., L.L.C.
• Midwest Physical Therapy
• Payton Mifflin

• Pediatric Nurse Practitioner in Rochelle, IL
• Providers in Rochelle, IL by specialty
• Pediatric Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.