Individual provider Active NPI

Glenda Nelson-Annang

  • Family Nurse Practitioner
  • Chicago, IL
National Provider Identifier
1386161875
Registry record updated Jan 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
277002307 Issued in IL
Practice address
564 W Randolph St FL 2
Chicago, IL 60661-2219
Phone
(847) 448-0400
NPI assigned
Aug 24, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2025

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 277002307 IL Primary

Addresses

Primary practice location

564 W Randolph St FL 2
Chicago, IL 60661-2219

Mailing address

6717 S Cornell Ave Apt 1
Chicago, IL 60649-1059

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, IN2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20200116002208 IL Practitioner - Nurse Practitioner 9931534161 Reassigns benefits to 1 organization
I20210617001673 IN Practitioner - Nurse Practitioner 9931534161 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
NPS for YouGroup PAC ID 5597291864, 2 clinicians

Practice addresses (Care Compare)

6717 S Cornell Ave
Chicago, IL 60649-1151
Phone (630) 447-9540

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
277002307ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
NPS for You CurrentSince Dec 11, 2024 Accepting new patients
Universal Healthclinics, SC PastSince Apr 3, 2006 Accepting new patients

Locations

930 E 162nd St
Ste B
South Holland, IL 60473

Interoperability endpoints

  • Direct secure messaging: glenda.nelson-annang.1@32075.direct.athenahealth.com
  • Direct secure messaging: gnelsonannang20818@carelonhealth.direct-ci.com

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": "1503532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736726400000",
    "number": "1386161875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6717 S CORNELL AVE APT 1",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606491059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "564 W RANDOLPH ST FL 2",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606612219",
            "telephone_number": "847-448-0400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON-ANNANG",
        "first_name": "GLENDA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-24",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "277002307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.