Kelly Tais Azambuja Cachoeira, APRN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

209029354 Issued in IL

Practice address

2151 Waukegan Rd Ste 100
Bannockburn, IL 60015-1885

Phone

(847) 444-5300

NPI assigned

Feb 13, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

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

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 and National Provider Directory roles.

• Endeavor Health Medical Group

  • Emergency Medicine Physician
  • Evanston, IL
  • NPI 1497701882

  IL

  Medicare reassignment Care Compare group NPD
• Endeavor Health Medical Group

  • Anesthesiology Physician
  • Evanston, IL
  • NPI 1265695944
  NPD

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

• Endeavor Health Clinical Operations

  • General Acute Care Hospital
  • Evanston, IL
  • NPI 1184670549

  Hospital

  Care Compare affiliation

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Endeavor Health Medical Group 3,330 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northshore University Healthsystem - Evanston Hospital Hospital, Evanston, IL, CCN 140010

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

{
    "created_epoch": "1707782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722988800000",
    "number": "1295599900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2151 WAUKEGAN RD STE 100",
            "city": "BANNOCKBURN",
            "state": "IL",
            "postal_code": "600151885",
            "telephone_number": "847-444-5300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2151 WAUKEGAN RD STE 100",
            "city": "BANNOCKBURN",
            "state": "IL",
            "postal_code": "600151885",
            "telephone_number": "847-444-5300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1103 S Hunt Club Dr Apt 319",
            "address_purpose": "LOCATION",
            "city": "Mount Prospect",
            "state": "IL",
            "postal_code": "600564274",
            "country_code": "US",
            "telephone_number": "630-605-7875",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AZAMBUJA CACHOEIRA",
        "first_name": "KELLY TAIS",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-13",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209029354",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen E. Anderson,, PA-C
• Jill Frances Apel, M.D.
• Athletico LTD
• Sebastino Aviles, LCSW, MPH
• Tariq U. Azam, MD
• Katerina Marie Bakhos, M.D
• Marisa Baldassano, PA-C
• Caren Baltasi, LDN,CCN
• Bannockburn Chiropractic & Sports Injury Center PC
• Bannockburn Family Wellness

• All providers in Bannockburn, IL
• Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2024; 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.