Individual provider Active NPI

Shauna Vandermey

  • Nurse Practitioner
  • Willowbrook, IL
National Provider Identifier
1407456171
Registry record updated Dec 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209022383 Issued in IL
Practice address
40 75TH St
Willowbrook, IL 60527-2325
Phone
(630) 581-5372
Fax
(630) 568-3247
NPI assigned
Oct 30, 2020
Last updated
Dec 10, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 209022383 IL Primary
Registered Nurse 163W00000X 041449789 IL

Addresses

Primary practice location

40 75TH St
Willowbrook, IL 60527-2325

Mailing address

40 75TH St
Willowbrook, IL 60527-2325
Phone (630) 581-5372

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
I20201124001358 IL Practitioner - Nurse Practitioner 7214348242 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Midwest Express Care 2, IncGroup PAC ID 0547495467, 221 clinicians
Physicians Immediate Care North Chicago LLCGroup PAC ID 8729064159, 256 clinicians

Practice addresses (Care Compare)

40 75TH St
Willowbrook, IL 60527-2325
Phone (630) 581-5372

4460 N Harlem Ave
Norridge, IL 60706-4745
Phone (708) 402-9140

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
041449789ILMDRegistered Nurse
209022383ILMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Physicians Immediate Care North Chicago LLC CurrentSince Dec 1, 2025 Accepting new patients
Midwest Express Care 2, Inc CurrentSince Nov 6, 2020 Accepting new patients
Midwest Express Care 2, Inc CurrentSince Nov 6, 2020 Accepting new patients

Locations

12200 Western Ave
Blue Island, IL 60406
Phone (630) 581-5372

4211 N Cicero Ave
Chicago, IL 60641
Phone (773) 794-1000

800 W Fulton Market
Fl 12
Chicago, IL 60607

335 E Army Trail Rd
Glendale Heights, IL 60139
Phone (630) 389-1681

4460 N Harlem Ave
Norridge, IL 60706
Phone (708) 402-9140

40 75th St
Willowbrook, IL 60527
Phone (630) 326-5312

2015 Sheridan Rd
Zion, IL 60099
Phone (224) 447-0370

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1604016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607558400000",
    "number": "1407456171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 75TH ST",
            "city": "WILLOWBROOK",
            "state": "IL",
            "postal_code": "605272325",
            "telephone_number": "630-581-5372",
            "fax_number": "630-568-3247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 75TH ST",
            "city": "WILLOWBROOK",
            "state": "IL",
            "postal_code": "605272325",
            "telephone_number": "630-581-5372",
            "fax_number": "630-568-3247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDERMEY",
        "first_name": "SHAUNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-30",
        "last_updated": "2020-12-10",
        "certification_date": "2020-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209022383",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041449789",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Willowbrook, IL

Sources for this page

Verify at the official NPI Registry.