Individual provider Active NPI

Ellen Christine Seymour, AGNP-C

  • Adult Health Nurse Practitioner
  • Chicago, IL
National Provider Identifier
1295291581
Registry record updated Mar 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
209.020556041.488312 Issued in IL
Practice address
5401 S Wentworth Ave
Chicago, IL 60609-6300
Phone
(773) 288-6900
NPI assigned
Feb 12, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 209.020556041.488312 IL Primary

Addresses

Primary practice location

5401 S Wentworth Ave
Chicago, IL 60609-6300

Mailing address

5401 S Wentworth Ave
Chicago, IL 60609-6300
Phone (773) 288-6900

Other practice location 1

1522 Janes Ave
Saginaw, MI 48601-1819
Phone (989) 755-0316

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
I20200326002633 IL Practitioner - Nurse Practitioner 6709126410 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Access Community Health NetworkGroup PAC ID 9537076112, 182 clinicians

Practice addresses (Care Compare)

5401 S Wentworth Ave
Chicago, IL 60609-6300
Phone (773) 288-6900

7450 W 63Rd St
Des Plaines Valley Family Health Center
Summit, IL 60501-1816
Phone (708) 458-0757

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
209.020556041.488312ILMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Access Community Health Network CurrentSince Mar 9, 2020 Accepting new patients
Access Community Health Network Current Accepting new patients
Access Community Health Network CurrentSince Mar 9, 2020 Accepting new patients
Access Community Health Network Past Accepting new patients

Locations

600 W Fulton St
Ste 200
Chicago, IL 60661
Phone (312) 526-2000

5401 S Wentworth Ave
Chicago, IL 60609
Phone (773) 268-5664

Interoperability endpoints

  • Direct secure messaging: eseymour17130@direct.achn.net

Organizations & group practices 4

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": "1549929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584576000000",
    "number": "1295291581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5401 S WENTWORTH AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606096300",
            "telephone_number": "773-288-6900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5401 S WENTWORTH AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606096300",
            "telephone_number": "773-288-6900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1522 Janes Ave",
            "address_purpose": "LOCATION",
            "city": "Saginaw",
            "state": "MI",
            "postal_code": "486011819",
            "country_code": "US",
            "telephone_number": "989-755-0316",
            "fax_number": "989-755-0956",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SEYMOUR",
        "first_name": "ELLEN",
        "middle_name": "CHRISTINE",
        "credential": "AGNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-12",
        "last_updated": "2020-03-19",
        "certification_date": "2020-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IL",
            "license": "209.020556041.488312",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.