Tara A De Jesus, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036108171 Issued in IL

Practice address

3860 W Ogden Ave
Chicago, IL 60623-2460

Phone

(872) 588-3000

NPI assigned

May 31, 2006

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

Other identifiers 2

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Pediatric Medicine

Education

Rush Medical College of Rush University, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lawndale Christian Health CenterGroup PAC ID 2264336346, 124 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tdejesus690722@direct.ochin.org

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.

• Lawndale Christian Health Center

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1245289214
  Medicare reassignment Care Compare group NPD
• Access Community Health Network

  • Federally Qualified Health Center (FQHC)
  • Des Plaines, IL
  • NPI 1982783692
  Medicare reassignment NPD
• Access Community Health Network

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1467695809
  NPD
• Access Community Health Network

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1699701383
  NPD
• Lawndale Christian Health Center

  • Health Educator
  • Chicago, IL
  • NPI 1588537641
  NPD
• Lawndale Christian Health Center

  • Community/Retail Pharmacy
  • Chicago, IL
  • NPI 1679680235
  NPD
• Access Community Health Network

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1598844268
  NPD (past)

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1477590651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3229-43 W 47TH PL.",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606323011",
            "telephone_number": "773-254-6044",
            "fax_number": "773-254-6115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3860 W OGDEN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606232460",
            "telephone_number": "872-588-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE JESUS",
        "first_name": "TARA",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-31",
        "last_updated": "2023-03-07",
        "certification_date": "2021-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036108171",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CS LICENSE",
            "identifier": "336069630",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "036108171",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shaun De Guzman, DPT
• Sergei Xavier De Hoyos
• Monica Lynn De Iorio, PHD
• Elisha De Jesus
• Sandra Maria De Jesus, PT,DPT
• David John De Jong, M.D.
• Elisa Marie De Jong, C.O.
• Jill L De Jong, MD
• Katherine De Jong
• Anna De la Cotera

• Pediatrics Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.