Organization Active NPI

Mycare Express Care Inc

  • Specialist
  • Bloomington, IL
National Provider Identifier
1396464657
Registry record updated Mar 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
MYCARE EXPRESS CARE INC
Practice address
1404 Eastland Dr Ste 103
Bloomington, IL 61701-7904
Phone
(309) 319-2393
NPI assigned
Aug 22, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2025

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

Authorized official

Name
Jibran Naseer, MDNPI 1821261892
Title
Owner
Phone
(309) 319-2393

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 174400000X Primary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X

Addresses

Primary practice location

1404 Eastland Dr Ste 103
Bloomington, IL 61701-7904

Mailing address

1404 Eastland Dr Ste 103
Bloomington, IL 61701-7904
Phone (309) 319-2393

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20221028002232 IL Part B Supplier - Clinic/Group Practice 3870960172 Receives reassigned benefits from 6 practitioners
Practice locations: Bloomington, IL
O20230714002605 IL DME Supplier - Multi-Specialty - Physician 3870960172 Practice locations: Bloomington, IL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D2266349Mycare Express Care Inc1404 Eastland Dr - Ste 103, Bloomington, IL 61701Certificate of waiverAug 8, 2026

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1661126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742860800000",
    "number": "1396464657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1404 EASTLAND DR STE 103",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617017904",
            "telephone_number": "309-319-2393",
            "fax_number": "309-585-2607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1404 EASTLAND DR STE 103",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617017904",
            "telephone_number": "309-319-2393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYCARE EXPRESS CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-22",
        "last_updated": "2025-03-25",
        "certification_date": "2025-03-25",
        "status": "A",
        "authorized_official_last_name": "NASEER",
        "authorized_official_first_name": "JIBRAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "309-319-2393",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.