Heidi Wagner

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209014217 Issued in IL

Practice address

545 Plainfield Rd Ste G-1
Willowbrook, IL 60527-7600

Phone

(708) 405-8025

Fax

(763) 205-9350

NPI assigned

Oct 28, 2016

Sex

Female

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

Specialty

Nurse Practitioner

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Moments Palliative Care LLCGroup PAC ID 0143561480, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Moments Palliative Care LLC

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Des Plaines, IL
  • NPI 1972290724
  Medicare reassignment Care Compare group NPD
• Moments Hospice of Chicago South LLC

  • Community Based Hospice Care Agency
  • Willowbrook, IL
  • NPI 1831790906
  NPD
• Moments Palliative Care LLC

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Miami Lakes, FL
  • NPI 1578253894
  NPD
• Banyan Treatment Center Il, LLC

  • Substance Abuse Rehabilitation Facility
  • Lisle, IL
  • NPI 1366811820
  NPD (past)
• Midwest Post Acute Care LLC

  • Nursing Facility/Intermediate Care Facility
  • Chicago, IL
  • NPI 1760931513
  NPD (past)

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

{
    "created_epoch": "1477612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706659200000",
    "number": "1447702147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "545 PLAINFIELD RD STE G-1",
            "city": "WILLOWBROOK",
            "state": "IL",
            "postal_code": "605277600",
            "telephone_number": "630-205-0101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 PLAINFIELD RD STE G-1",
            "city": "WILLOWBROOK",
            "state": "IL",
            "postal_code": "605277600",
            "telephone_number": "708-405-8025",
            "fax_number": "763-205-9350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "HEIDI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-28",
        "last_updated": "2024-01-31",
        "certification_date": "2024-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209014217",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jensen Jacob Vayalil
• Mejo Vayalil
• VTM Insurance Financial Services
• Marija Vujovic
• Agnieszka Malgorzata Waclaw, NP
• Maribel D Wagner
• Walgreen Co
• Walgreen Co
• Walgreen Co.
• Brittany Walker, DNP

• Family Nurse Practitioner in Willowbrook, IL
• Providers in Willowbrook, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.