Individual provider Active NPI

Carolyn Alys Rydberg, APRN

  • Family Nurse Practitioner
  • Chicago, IL
National Provider Identifier
1356804439
Registry record updated Sep 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209018699 Issued in IL
Practice address
4009 N Broadway St
Chicago, IL 60613-2110
Phone
(773) 275-2586
NPI assigned
Apr 7, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2024

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 209018699 IL Primary

Addresses

Primary practice location

4009 N Broadway St
Chicago, IL 60613-2110

Mailing address

4009 N Broadway St
Chicago, IL 60613-2110
Phone (773) 275-2586

Other practice location 1

3816 N Claremont Ave # 2
Chicago, IL 60618-3818
Phone (773) 726-2843

Other practice location 2

4600 N Ravenswood Ave Fl 1
Chicago, IL 60640-4510
Phone (773) 561-7500

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
I20200630000014 IL Practitioner - Nurse Practitioner 9436587268 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4600 N Ravenswood Ave
Chicago, IL 60640-4510
Phone (773) 561-7500

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209018699ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Advocate Health and Hospitals Corporation CurrentSince Jul 1, 2022 Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Jun 18, 2022 Accepting new patients
Advocate Health & Hospitals Corp. CurrentSince Jun 18, 2022 Accepting new patients

Locations

214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160

29373 Network Pl
Chicago, IL 60673

Interoperability endpoints

  • Direct secure messaging: crydberg342633@direct.myadvocateaurora.org

Organizations & group practices 3

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": "1554595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727395200000",
    "number": "1356804439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4009 N BROADWAY ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606132110",
            "telephone_number": "773-275-2586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4009 N BROADWAY ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606132110",
            "telephone_number": "773-275-2586"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3816 N Claremont Ave # 2",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606183818",
            "country_code": "US",
            "telephone_number": "773-726-2843",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4600 N Ravenswood Ave Fl 1",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606404510",
            "country_code": "US",
            "telephone_number": "773-561-7500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RYDBERG",
        "first_name": "CAROLYN",
        "middle_name": "ALYS",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-07",
        "last_updated": "2024-09-27",
        "certification_date": "2024-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209018699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.