NPIMap

Individual provider Active NPI

Nisha Mathew

  • Pharmacist
  • Crystal Lake, IL
National Provider Identifier
1376990820
Registry record updated May 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
IL051040206 Issued in IL
Practice address
6140 Northwest Hwy
Crystal Lake, IL 60014-7931
Phone
(815) 356-8767
Fax
(815) 356-8790
NPI assigned
May 14, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X IL051040206 IL Primary

Addresses

Primary practice location

6140 Northwest Hwy
Crystal Lake, IL 60014-7931

Mailing address

6140 Northwest Hwy
Crystal Lake, IL 60014-7931
Phone (815) 356-8767

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

LicenseStateTypeSpecialty
IL051040206ILMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
American Drug Stores LLC Past Accepting new patients
American Drug Stores LLC Past Accepting new patients

Organizations & group practices 2

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": "1463184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1463184000000",
    "number": "1376990820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6140 NORTHWEST HWY",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600147931",
            "telephone_number": "815-356-8767",
            "fax_number": "815-356-8790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6140 NORTHWEST HWY",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600147931",
            "telephone_number": "815-356-8767",
            "fax_number": "815-356-8790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHEW",
        "first_name": "NISHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-14",
        "last_updated": "2016-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IL",
            "license": "IL051040206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crystal Lake, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.