Individual provider Active NPI

Donna McCormack, APN

  • Nurse Practitioner
  • Maywood, IL
National Provider Identifier
1396878682
Registry record updated Jun 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209000481 Issued in IL
Practice address
2160 S First Ave
101 1740 Loyola University Medical Center
Maywood, IL 60153
Phone
(708) 216-9000
Fax
(708) 216-9033
NPI assigned
Mar 14, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X 041248666 IL
Nurse Practitioner 363L00000X 209000481 IL Primary

Addresses

Primary practice location

2160 S First Ave
101 1740 Loyola University Medical Center
Maywood, IL 60153

Mailing address

2160 S First Ave
101 1740 Loyola University Medical Center
Maywood, IL 60153
Phone (708) 216-9000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dmccormack14869@direct.luhs.org Other

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
I20071213000103 IL Practitioner - Nurse Practitioner 8527158633 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Loyola University Medical CenterGroup PAC ID 3779488903, 917 clinicians

Practice addresses (Care Compare)

1950 Harlem Ave
North Riverside, IL 60546-1470
Phone (708) 354-9250

2160 S 1St Ave
Maywood, IL 60153-3328
Phone (708) 216-9000

300 N York Rd
Elmhurst, IL 60126-2318
Phone (630) 833-0630

6800 N Frontage Rd
Burr Ridge, IL 60527-7819
Phone (708) 327-1000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
041248666ILMDWomen's Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Loyola University Medical Center CurrentSince Aug 30, 2010 Accepting new patients
Loyola University Medical Center Current Accepting new patients
Loyola University Medical Center CurrentSince Aug 30, 2010 Accepting new patients
Loyola University Physician Foundation Past Accepting new patients

Locations

420 W Butterfield Rd
Elmhurst, IL 60126
Phone (630) 832-2300

9608 S Roberts Rd
Hickory Hills, IL 60457
Phone (708) 233-5333

500 W Court St
Kankakee, IL 60901
Phone (800) 585-4119

2160 S 1st Ave
Maywood, IL 60153
Phone (708) 216-4400

2160 S 1st Ave
#101
Maywood, IL 60153
Phone (708) 216-8785

1950 Harlem Ave
North Riverside, IL 60546
Phone (708) 354-9250

2 Westbrook Corporate Ctr
Ste 600
Westchester, IL 60154
Phone (708) 216-5092

Organizations & group practices 4

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654560000000",
    "number": "1396878682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2160 S FIRST AVE",
            "address_2": "101 1740 LOYOLA UNIVERSITY MEDICAL CENTER",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "60153",
            "telephone_number": "708-216-9000",
            "fax_number": "708-216-9033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 S FIRST AVE",
            "address_2": "101 1740 LOYOLA UNIVERSITY MEDICAL CENTER",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "60153",
            "telephone_number": "708-216-9000",
            "fax_number": "708-216-9033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCORMACK",
        "first_name": "DONNA",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-14",
        "last_updated": "2022-06-07",
        "certification_date": "2022-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "IL",
            "license": "041248666",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209000481",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dmccormack14869@direct.luhs.org",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "2160 S First Ave",
            "address_2": "101 1740 Loyola University Medical Center",
            "city": "Maywood",
            "state": "IL",
            "country_code": "US",
            "postal_code": "60153",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Maywood, IL

Sources for this page

Verify at the official NPI Registry.