Individual provider Active NPI

Adaku Juliet Obodoakor, NP

  • Family Nurse Practitioner
  • Hazel Crest, IL
National Provider Identifier
1336899236
Registry record updated Mar 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209.024823 Issued in IL
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

Updated by the provider on Mar 24, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

LicenseStateTypeSpecialty
209.024823ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Signify Health Medical Associates, PLLC CurrentSince Feb 1, 2025 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

Verify at the official NPI Registry.