Active NPI
Mary Grasso
- Pediatric Nurse Practitioner
- Chicago, IL
National Provider Identifier
1437748852
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 209022601
- Practice address
- 4254 W 55TH St
Chicago, IL 60632-4642 - Phone
- (773) 582-5200
- NPI assigned
- Jan 11, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 209022601 | IL | Primary |
Addresses
Primary practice location
4254 W 55TH St
Chicago, IL 60632-4642
Mailing address
840 N Spring Ave
La Grange Park, IL 60526-1475
Phone (708) 525-4065
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209022601 | IL | MD | Pediatric Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1610323200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610323200000",
"number": "1437748852",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "840 N SPRING AVE",
"city": "LA GRANGE PARK",
"state": "IL",
"postal_code": "605261475",
"telephone_number": "708-525-4065"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4254 W 55TH ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606324642",
"telephone_number": "773-582-5200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRASSO",
"first_name": "MARY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-01-11",
"last_updated": "2021-01-11",
"certification_date": "2020-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "IL",
"license": "209022601",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.