Individual provider Active NPI

Maureen Pascual Raiz, APN

  • Psychiatric/Mental Health Nurse Practitioner
  • Wheaton, IL
National Provider Identifier
1306559604
Registry record updated Sep 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
209.026640 Issued in IL
Practice address
55 E Loop Rd
Wheaton, IL 60189-1938
Phone
(884) 287-8908
Fax
(877) 428-7891
NPI assigned
Jan 2, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 209.026640 IL Primary

Addresses

Primary practice location

55 E Loop Rd
Wheaton, IL 60189-1938

Mailing address

55 E Loop Rd
Wheaton, IL 60189-1938
Phone (708) 856-5660

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
I20230913001784 IL Practitioner - Nurse Practitioner 3779947411 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Edgewood Clinical Services P.C.Group PAC ID 3971963901, 304 clinicians

Practice addresses (Care Compare)

55 E Loop Rd
Wheaton, IL 60189-1938
Phone (888) 428-7890

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209.026640ILMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Edgewood Clinical Services, P.C. Psychiatric/Mental Health CurrentSince Aug 7, 2023 Accepting new patients
Aleksandr Dekhtyar MD SC CurrentSince Oct 29, 2023 Accepting new patients
Psychology Specialists LTD Past Accepting new patients

Locations

808 S Eldorado Rd
Ste 102
Bloomington, IL 61704
Phone (309) 212-6007

2500 W Higgins Rd
Ste 210
Hoffman Estates, IL 60169
Phone (224) 489-3888

3027 English Rows Ave
Ste 201
Naperville, IL 60564

2948 Artesian Rd
Ste 112
Naperville, IL 60564
Phone (630) 328-0165

55 E Loop Rd
Ste 112
Wheaton, IL 60189

55 E Loop Rd
Ste 301
Wheaton, IL 60189
Phone (630) 690-7300

55 E Loop Rd
Wheaton, IL 60189
Phone (630) 653-8899

Interoperability endpoints

  • Direct secure messaging: lifestancehealth.maureenraiz@146897.advancedmd-direct.com

Organizations & group practices 3

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": "1672617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726444800000",
    "number": "1306559604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 E LOOP RD",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601891938",
            "telephone_number": "708-856-5660",
            "fax_number": "630-328-0144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 E LOOP RD",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601891938",
            "telephone_number": "884-287-8908",
            "fax_number": "877-428-7891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAIZ",
        "first_name": "MAUREEN",
        "middle_name": "PASCUAL",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-02",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "209.026640",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wheaton, IL

Sources for this page

Verify at the official NPI Registry.