Tiffany Claire Wakim Ghantous, MSN, APRN, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209.028519 Issued in IL

Practice address

2955 W 95TH St
Evergreen Park, IL 60805-2409

Phone

(708) 422-0022

NPI assigned

Oct 23, 2023

Last updated

Mar 23, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Tiffany Wakim Former name

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

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Great Lakes Emergency Physicians Medical Group SCGroup PAC ID 8527493105, 15 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing

State licenses

Practice roles

Locations

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.

• Great Lakes Emergency Physicians Medical Group SC

  • Emergency Medicine Physician
  • Chicago, IL
  • NPI 1689212581
  Medicare reassignment Care Compare group
• Diabetes & Endocrine Care LTD

  • Endocrinology, Diabetes & Metabolism Physician
  • Evergreen Park, IL
  • NPI 1689627168
  Medicare reassignment NPD
• Rush University Medical Group

  dba Rush University Internists

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1093819542
  Medicare reassignment NPD
• Rush University Medical Center

  dba Radiology Services

  • Diagnostic Radiology Physician
  • Chicago, IL
  • NPI 1184269425
  NPD

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

{
    "created_epoch": "1698019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774224000000",
    "number": "1396517496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 E ILLINOIS ST UNIT 5509",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606110820",
            "telephone_number": "630-408-3563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2955 W 95TH ST",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608052409",
            "telephone_number": "708-422-0022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAKIM GHANTOUS",
        "first_name": "TIFFANY",
        "middle_name": "CLAIRE",
        "credential": "MSN, APRN, FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-10-23",
        "last_updated": "2026-03-23",
        "certification_date": "2026-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.028519",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TIFFANY",
            "last_name": "WAKIM",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Wal-Mart Stores, Inc (Vision Center 30-5485)
• Walgreen Co (Walgreens #15635)
• Walgreen Co (Walgreens #09141)
• Walgreen Co. (Walgreens #9141)
• Brianna Marie Wallace, PHARMD

• Family Nurse Practitioner in Evergreen Park, IL
• Providers in Evergreen Park, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.