Mateo M Betanzos, FNP/BC
Individual provider Active NPI Family Nurse Practitioner · Chicago, IL
NPI 1457767998 · NPPES record last updated Jan 10, 2018
Key facts
- NPI
- 1457767998
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 209011574 (IL)
- Practice address
- 1337 W 19TH St
Chicago, IL 60608-3896 - Phone
- (312) 563-9517
- NPI assigned
- Jul 4, 2014
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 18
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- TJ Siddiqui Inc
Practice addresses (Care Compare)
45 W 111TH St
Chicago, IL 60628-4200
Phone (773) 995-3000
Hospital & facility affiliations
- Holy Cross Hospital
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 |
|---|---|---|---|---|
| I20140806000984 | IL | Practitioner - Nurse Practitioner | 4486871050 | Reassigns benefits to 6 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209011574 | IL | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advocate Health and Hospitals Corporation | Current |
Accepting new patients | |
| Paragon Clinical LLC | Family | Current |
Accepting new patients |
| Cook County | Current | Accepting new patients | |
| CMC Healthcare LLC | Current |
Accepting new patients | |
| Cook County | Current |
Accepting new patients | |
| TJ Siddiqui Inc | Current |
Accepting new patients | |
| Esperanza Health Centers | Current |
Accepting new patients | |
| The Board of Trustees of the University of Illinois | Current |
Accepting new patients | |
| Esperanza Health Centers | Current |
Accepting new patients | |
| The Board of Trustees of the University of Illinois | Current | Accepting new patients | |
| Cook County | Current |
Accepting new patients | |
| The Board of Trustees of the University of Illinois | Current |
Accepting new patients | |
| Advocate Health & Hospitals Corp. | Current |
Accepting new patients | |
| Esperanza Health Centers | Current | Accepting new patients | |
| Advocate Health and Hospitals Corporation | Current | Accepting new patients | |
| Board of Trustees of the University of Illinois | Past | Accepting new patients | |
| Howard Brown Health Center | Past | Accepting new patients | |
| Paragon Clinical Midwest, LLC | Past | Accepting new patients |
Locations
214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160
5400 W 87th St
Burbank, IL 60459
Phone (708) 346-6236
1333 Burr Ridge Pkwy
Ste 200
Burr Ridge, IL 60527
Phone (630) 308-8706
7732 Solution Ctr
Chicago, IL 60677
Phone (312) 355-6290
29373 Network Pl
Chicago, IL 60673
2451 W Touhy Ave
Chicago, IL 60645
Phone (312) 593-5599
2001 S California Ave
Ste 100
Chicago, IL 60608
Phone (773) 640-5785
1713 S Ashland Ave
Chicago, IL 60608
Phone (312) 421-5382
2001 S California Ave
Chicago, IL 60608
Phone (773) 484-1201
1940 S Western Ave
#205
Chicago, IL 60608
Phone (631) 877-0913
1901 W Harrison St
Chicago, IL 60612
Phone (312) 864-5100
1740 W Taylor St
#3200
Chicago, IL 60612
Phone (312) 996-4021
500 E 51st St
Chicago, IL 60615
Phone (312) 572-2000
45 W 111th St
Chicago, IL 60628
Phone (773) 995-3000
722 W Maxwell St
#235
Chicago, IL 60607
Phone (312) 433-4114
2201 Main St
Evanston, IL 60202
Phone (847) 905-3000
Interoperability endpoints
- https://api.platform.athenahealth.com/11903/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 209011574 | IL | Yes |
Addresses
Primary practice location
1337 W 19TH St
Chicago, IL 60608-3896
Mailing address
4025 N Sheridan Rd
Chicago, IL 60613-2010
Phone (773) 388-1600
Other providers in Chicago, IL
- Christine Marie Bestvina
- Monica Beszka
- Beta Lab Services Inc
- Gabriela Beatriz Betancourt
- Jasmine Betancourt
- Madelyn Marie Betar
- Alan D. Betensley
- Beth Adams Medical Services PLLC
- Beth Anne Extended Living
- Beth Hennessey, P.C.
All providers in Chicago, IL · Family 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 Jan 10, 2018. 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.