Individual provider Active NPI

Carly Britt Moseberry, APN-CNP

  • Nurse Practitioner
  • Glenview, IL
National Provider Identifier
1356069207
Registry record updated Aug 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209025304 Issued in IL
Practice address
2050 Pfingsten Rd. Suite 330
Glenview, IL 60026-1300
Phone
(847) 570-2868
Fax
(847) 733-5005
NPI assigned
Aug 17, 2022
Last updated
Aug 16, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 209025304 IL
Nurse Practitioner 363L00000X 209025304 IL Primary

Addresses

Primary practice location

2050 Pfingsten Rd. Suite 330
Glenview, IL 60026-1300

Mailing address

2650 Ridge Ave. Suite 1223
Evanston, IL 60201-1718
Phone (847) 570-2040

Other practice location 1

2650 Ridge Ave.
Evanston, IL 60201-1718
Phone (847) 570-2868

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
I20221103002616 IL Practitioner - Nurse Practitioner 2163899154 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Rush Medical College of Rush University, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Endeavor Health Medical GroupGroup PAC ID 2163334699, 3,330 clinicians

Practice addresses (Care Compare)

2050 Pfingsten Rd
Suite 330
Glenview, IL 60026-1300
Phone (847) 998-4100

2100 Pfingsten Rd
Glenview, IL 60026-1301

2650 Ridge Ave
Evanston, IL 60201-1700

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
209025304ILMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Vitae Health Medical Illinois, PLLC CurrentSince Aug 16, 2023 Accepting new patients
Endeavor Health Medical Group CurrentSince Jul 26, 2024 Accepting new patients
Endeavor Health Medical Group CurrentSince Jul 26, 2024 Accepting new patients
Eaves Health Partners PLLC CurrentSince Sep 15, 2022 Accepting new patients

Locations

2055 W Balmoral Ave
Chicago, IL 60625
Phone (773) 561-8661

303 E Wacker Dr
Ste 1127
Chicago, IL 60601
Phone (312) 328-2347

6700 N Damen Ave
Chicago, IL 60645
Phone (773) 465-5000

7445 N Sheridan Rd
Chicago, IL 60626
Phone (773) 338-3300

9532 Eagle Way
Chicago, IL 60678

2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206

2650 Ridge Ave
Ste 1223
Evanston, IL 60201
Phone (847) 982-3175

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

2050 Pfingsten Rd
Glenview, IL 60026
Phone (847) 657-1820

2050 Pfingsten Rd
Ste 330
Glenview, IL 60026
Phone (847) 570-2868

5151 Church St
Skokie, IL 60077
Phone (773) 436-6600

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1660694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723766400000",
    "number": "1356069207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 RIDGE AVE. SUITE 1223",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011718",
            "telephone_number": "847-570-2040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2050 PFINGSTEN RD. SUITE 330",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600261300",
            "telephone_number": "847-570-2868",
            "fax_number": "847-733-5005"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2650 Ridge Ave.",
            "address_purpose": "LOCATION",
            "city": "Evanston",
            "state": "IL",
            "postal_code": "602011718",
            "country_code": "US",
            "telephone_number": "847-570-2868",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOSEBERRY",
        "first_name": "CARLY",
        "middle_name": "BRITT",
        "name_prefix": "Ms.",
        "credential": "APN-CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-17",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IL",
            "license": "209025304",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209025304",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glenview, IL

Sources for this page

Verify at the official NPI Registry.