Faustina Adenuga
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Chicago, IL
NPI 1417697202 · NPPES record last updated Mar 30, 2022
Key facts
- NPI
- 1417697202
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 209024453 (IL)
- Practice address
- 6821 S Halsted St
Chicago, IL 60621-1833 - Phone
- (773) 651-3629
- NPI assigned
- Mar 30, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Edgewood Clinical Services P.C.
Practice addresses (Care Compare)
250 S Northwest Hwy
Suite 110
Park Ridge, IL 60068-4237
Phone (888) 428-7890
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231002002025 | IL | Practitioner - Nurse Practitioner | 1557715083 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209024453 | IL | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Edgewood Clinical Services, P.C. | Psychiatric/Mental Health | Current |
Accepting new patients |
| Grow Healthcare Group PA | Psychiatric/Mental Health | Current |
Accepting new patients |
| Beth Psychiatry LLC | Psychiatric/Mental Health | Past | Accepting new patients |
| Psychology Specialists LTD | Past | Accepting new patients | |
| Edgewood Clinical Services, P.C. | Past | Accepting new patients |
Locations
808 S Eldorado Rd
Ste 102
Bloomington, IL 61704
Phone (309) 212-6007
605 N Michigan Ave
Fl 4
Chicago, IL 60611
Phone (773) 232-5338
3027 English Rows Ave
Ste 201
Naperville, IL 60564
2948 Artesian Rd
Ste 112
Naperville, IL 60564
Phone (630) 328-0165
250 S Northwest Hwy
Ste 110
Park Ridge, IL 60068
Phone (224) 422-2149
Interoperability endpoints
- lifestancehealth.faustinaadenuga@146897.advancedmd-direct.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 209024453 | IL | Yes |
Addresses
Primary practice location
6821 S Halsted St
Chicago, IL 60621-1833
Mailing address
6821 S Halsted St
Chicago, IL 60621-1833
Phone (773) 651-3629
Other providers in Chicago, IL
- Sarah Ashley Adelstein
- Muna Abdu Adem
- Adeshalewa Ademoyo-Opakunle
- Marilyn Sue Aden
- Adekunle Adeniji
- Zahra Adenwalla
- Adeola L Adeoye
- Samuel Adeoye
- Jubril Adepoju
- Ali A Ader
All providers in Chicago, IL · Psychiatric/Mental Health Nurse Practitioner in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 30, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.