Active NPI
Caren Baltasi, LDN,CCN
- Nutritionist
- Bannockburn, IL
National Provider Identifier
1346436508
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutritionist
- License
- 164.004395
- Practice address
- 2525 Waukegan Rd
Suite 255
Bannockburn, IL 60015-5514 - Phone
- (847) 405-7611
- NPI assigned
- Sep 21, 2007
- Last updated
- Apr 23, 2010
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Nutritionist | 133N00000X | 164.004395 | IL | Primary |
Addresses
Primary practice location
2525 Waukegan Rd
Suite 255
Bannockburn, IL 60015-5514
Mailing address
2525 Waukegan Rd
Suite 255
Bannockburn, IL 60015-5514
Phone (847) 405-7611
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164.004395 | IL | MD | Nutritionist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190332800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1271980800000",
"number": "1346436508",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2525 WAUKEGAN RD",
"address_2": "SUITE 255",
"city": "BANNOCKBURN",
"state": "IL",
"postal_code": "600155514",
"telephone_number": "847-405-7611"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2525 WAUKEGAN RD",
"address_2": "SUITE 255",
"city": "BANNOCKBURN",
"state": "IL",
"postal_code": "600155514",
"telephone_number": "847-405-7611"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALTASI",
"first_name": "CAREN",
"name_prefix": "Ms.",
"credential": "LDN,CCN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-09-21",
"last_updated": "2010-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": "IL",
"license": "164.004395",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bannockburn, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.