Individual provider Active NPI

Tia-Monique F Nelson, MSN, FP-APRN, FNP-C

  • Family Nurse Practitioner
  • Skokie, IL
National Provider Identifier
1306207733
Registry record updated Oct 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
277.001548 Issued in IL
Practice address
9977 Woods Dr
Skokie, IL 60077-1057
Phone
(224) 364-2273
NPI assigned
Mar 12, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 209014008 IL
Family Nurse Practitioner 363LF0000X 277.001548 IL Primary

Addresses

Primary practice location

9977 Woods Dr
Skokie, IL 60077-1057

Mailing address

9977 Woods Dr
Skokie, IL 60077-1057
Phone (224) 364-2273

Other practice location 1

7900 Rollins Rd
Gurnee, IL 60031-1512
Phone (224) 364-2273

Other names 1

  • Ms. Tia-Monique Faith Blash Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tnelson191722@direct.northshore.org

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
I20160321000004 IL Practitioner - Nurse Practitioner 8123325008 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Erie Family Health Center, IncGroup PAC ID 9537050422, 141 clinicians

Practice addresses (Care Compare)

1701 W Superior St
FL 2
Chicago, IL 60622-5646
Phone (312) 666-3494

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
277.001548ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Endeavor Health Medical Group Current Accepting new patients
Erie Family Health Center Inc. CurrentSince Jun 26, 2023 Accepting new patients
Endeavor Health Medical Group CurrentSince Apr 19, 2017 Accepting new patients
Erie Family Health Center, Inc Current Accepting new patients
Erie Family Health Center Inc CurrentSince Jun 26, 2023 Accepting new patients
Endeavor Health Clinical Operations PastSince Apr 19, 2017 Accepting new patients

Locations

1504 S Albany Ave
Chicago, IL 60623

1701 W Superior St
Fl 2
Chicago, IL 60622
Phone (323) 361-2122

1701 W Superior St
Fl 3
Chicago, IL 60622
Phone (312) 432-7381

9532 Eagle Way
Chicago, IL 60678

2650 Ridge Ave
Ste 1223
Evanston, IL 60201
Phone (847) 982-3175

2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

7900 Rollins Rd
Gurnee, IL 60031
Phone (847) 356-3680

7900 Rollins Rd
Fl 1
Gurnee, IL 60031
Phone (847) 998-4170

9977 Woods Dr
Skokie, IL 60077
Phone (847) 663-8540

Interoperability endpoints

  • Direct secure messaging: tnelson632424@direct.ochin.org

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": "1457740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634860800000",
    "number": "1306207733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9977 WOODS DR",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600771057",
            "telephone_number": "224-364-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9977 WOODS DR",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600771057",
            "telephone_number": "224-364-2273"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7900 Rollins Rd",
            "address_purpose": "LOCATION",
            "city": "Gurnee",
            "state": "IL",
            "postal_code": "600311512",
            "country_code": "US",
            "telephone_number": "224-364-2273",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NELSON",
        "first_name": "TIA-MONIQUE",
        "middle_name": "F",
        "name_prefix": "Mrs.",
        "credential": "MSN, FP-APRN, FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-12",
        "last_updated": "2021-10-22",
        "certification_date": "2021-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209014008",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "277.001548",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tnelson191722@direct.northshore.org",
            "affiliation": "N",
            "address_1": "9977 Woods Dr",
            "city": "Skokie",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600771057",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "TIA-MONIQUE",
            "last_name": "BLASH",
            "middle_name": "FAITH",
            "prefix": "MS.",
            "credential": "MSN, APN, FNP-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Skokie, IL

Sources for this page

Verify at the official NPI Registry.