Individual provider Active NPI

Erin Fruth, APN, AGCNS-BC

  • Nurse Practitioner
  • Maywood, IL
National Provider Identifier
1477903276
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209013564 Issued in IL
Practice address
2160 S 1St Ave
Loyola Medical Center, Department of Urology
Maywood, IL 60153
Phone
(708) 216-5100
Fax
(708) 216-1699
NPI assigned
Jun 13, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Clinical Nurse Specialist 364SA2200X 209013564 IL
Nurse Practitioner 363L00000X 209013564 IL Primary

Addresses

Primary practice location

2160 S 1St Ave
Loyola Medical Center, Department of Urology
Maywood, IL 60153

Mailing address

2160 S 1St Ave
Loyola Medical Center, Department of Urology
Maywood, IL 60153-3328
Phone (708) 216-5100

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address efruth31066@direct.luhs.org Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20160919001450 IL Practitioner - Nurse Practitioner 8921395906
I20180925000123 IL Practitioner - Certified Clinical Nurse Specialist (CNS) 8921395906

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209013564ILMDNurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1465776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1477903276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2160 S 1ST AVE",
            "address_2": "LOYOLA MEDICAL CENTER, DEPARTMENT OF UROLOGY",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601533328",
            "telephone_number": "708-216-5100",
            "fax_number": "708-216-1699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 S 1ST AVE",
            "address_2": "LOYOLA MEDICAL CENTER, DEPARTMENT OF UROLOGY",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "60153",
            "telephone_number": "708-216-5100",
            "fax_number": "708-216-1699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRUTH",
        "first_name": "ERIN",
        "credential": "APN, AGCNS-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-13",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SA2200X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Adult Health",
            "state": "IL",
            "license": "209013564",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209013564",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "efruth31066@direct.luhs.org",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "2160 S 1st Ave",
            "address_2": "Loyola Medical Center, Department of Urology",
            "city": "Maywood",
            "state": "IL",
            "country_code": "US",
            "postal_code": "60153",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Maywood, IL

Sources for this page

Verify at the official NPI Registry.