Active NPI
Adaku Juliet Obodoakor, NP
- Family Nurse Practitioner
- Hazel Crest, IL
National Provider Identifier
1336899236
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 209.024823
- Practice address
- 17700 Pebblewood LN
Hazel Crest, IL 60429-2151 - Phone
- (708) 620-9562
- NPI assigned
- Mar 24, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 209.024823 | IL | Primary |
Addresses
Primary practice location
17700 Pebblewood LN
Hazel Crest, IL 60429-2151
Mailing address
17700 Pebblewood LN
Hazel Crest, IL 60429-2151
Phone (708) 620-9562
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250225003027 | IL | Practitioner - Nurse Practitioner | 6305366014 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209.024823 | IL | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Signify Health Medical Associates, PLLC | Current | Accepting new patients |
Locations
4055 Valley View Ln
Ste 700
Dallas, TX 75244
Phone (469) 466-7424
Organizations & group practices 1
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": "1648080000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1648080000000",
"number": "1336899236",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17700 PEBBLEWOOD LN",
"city": "HAZEL CREST",
"state": "IL",
"postal_code": "604292151",
"telephone_number": "708-620-9562"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17700 PEBBLEWOOD LN",
"city": "HAZEL CREST",
"state": "IL",
"postal_code": "604292151",
"telephone_number": "708-620-9562"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OBODOAKOR",
"first_name": "ADAKU",
"middle_name": "JULIET",
"name_prefix": "Miss",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-03-24",
"last_updated": "2022-03-24",
"certification_date": "2022-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "IL",
"license": "209.024823",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Hazel Crest, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2022; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.