NPIMap

Individual provider Active NPI

Nancy Elizabeth Bryan, D.O.

  • Internal Medicine Physician
  • Plainfield, IL
National Provider Identifier
1316064272
Registry record updated Oct 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036.117275 Issued in IL
Practice address
15905 S Frederick St
Ste 105
Plainfield, IL 60586-7707
Phone
(630) 646-5020
NPI assigned
Mar 24, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036.117275 IL Primary

Addresses

Primary practice location

15905 S Frederick St
Ste 105
Plainfield, IL 60586-7707

Mailing address

15905 S Frederick St
Ste 105
Plainfield, IL 60586-7707
Phone (630) 646-5020

Other identifiers 2

IdentifierTypeStateIssuer
2220936OtherILBCBS
036117275 1MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
036.117275ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Edward Health Ventures Past Accepting new patients
Edward Health Ventures Past Accepting new patients
Edward Health Ventures Internal Medicine Past Accepting new patients
Edward Health Ventures Past Accepting new patients
Edward Health Ventures Internal Medicine Past Accepting new patients
Edward Health Ventures Past Accepting new patients
Edward Health Ventures Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: nbryan7985@direct.rush.rush-health.com

Organizations & group practices 7

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": "1174694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1224547200000",
    "number": "1316064272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15905 S FREDERICK ST",
            "address_2": "STE 105",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605867707",
            "telephone_number": "630-646-5020",
            "fax_number": "630-646-5025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15905 S FREDERICK ST",
            "address_2": "STE 105",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605867707",
            "telephone_number": "630-646-5020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRYAN",
        "first_name": "NANCY",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-24",
        "last_updated": "2008-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036.117275",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "2220936",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036117275 1",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plainfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2008; 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.