Jay Declarador

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

209016591 Issued in IL

Practice address

332 S Michigan Ave
Chicago, IL 60604-4434

Phone

(888) 660-4425

NPI assigned

Nov 10, 2017

Last updated

Nov 10, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

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.

• Illinois Medical Care LTD

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1508980889
  Medicare reassignment NPD
• Najjar Medical LTD

  • Pulmonary Disease Physician
  • Chicago, IL
  • NPI 1386731867
  Medicare reassignment NPD

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

{
    "created_epoch": "1510272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1510272000000",
    "number": "1417460502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5450 ASTOR LN APT 418",
            "city": "ROLLING MEADOWS",
            "state": "IL",
            "postal_code": "600084116",
            "telephone_number": "847-259-7173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "332 S MICHIGAN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606044434",
            "telephone_number": "888-660-4425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DECLARADOR",
        "first_name": "JAY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-11-10",
        "last_updated": "2017-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209016591",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Debra Eve Decker, COTA
• Genevieve Decker, DNP. AGACNP-BC
• Nicole Decker, OD
• Paul Xavier Decker, M.D.
• Victoria Lynn Decker
• Craig Matthew Declark, O.D.
• Michelle Decola
• Nicolle Decordova, M.S. CCC-SLP
• Anne Kirsti Decore, LMFT
• Nancy C Decorrevant, CRNA

• Nurse Practitioner in Chicago, IL
• Providers in Chicago, IL by specialty
• Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2017; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.