Active NPI
Patricia Coleman, RDN, CSSD
- Registered Dietitian
- Northbrook, IL
National Provider Identifier
1487272746
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 164004614
- Practice address
- 240 Red Oak Rd
Northbrook, IL 60062-1319 - Phone
- (312) 401-5111
- NPI assigned
- Jul 13, 2020
- Last updated
- Sep 2, 2020
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 164004614 | IL | Primary |
| Sports Dietetics Nutrition Registered Dietitian | 133VN1501X | 954008 |
Addresses
Primary practice location
240 Red Oak Rd
Northbrook, IL 60062-1319
Mailing address
240 Red Oak Rd
Northbrook, IL 60062-1319
Phone (312) 612-9255
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 164.004614 | Other | IL | LICENSED DIETITIAN NUTRITIONIST |
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 |
|---|---|---|---|
| 164004614 | IL | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Encouraged to Nourish LLC | Dietitian, Registered | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1594598400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1599004800000",
"number": "1487272746",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "240 RED OAK RD",
"city": "NORTHBROOK",
"state": "IL",
"postal_code": "600621319",
"telephone_number": "312-612-9255",
"fax_number": "312-668-8589"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "240 RED OAK RD",
"city": "NORTHBROOK",
"state": "IL",
"postal_code": "600621319",
"telephone_number": "312-401-5111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLEMAN",
"first_name": "PATRICIA",
"credential": "RDN, CSSD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-07-13",
"last_updated": "2020-09-02",
"certification_date": "2020-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "164004614",
"primary": true
},
{
"code": "133VN1501X",
"taxonomy_group": "",
"desc": "Dietitian, Registered, Nutrition, Sports Dietetics",
"state": null,
"license": "954008",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSED DIETITIAN NUTRITIONIST",
"identifier": "164.004614",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Northbrook, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.