Individual provider Active NPI

Marisol Glover

  • Psychiatric/Mental Health Nurse Practitioner
  • Waukegan, IL
National Provider Identifier
1497027262
Registry record updated Dec 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
209009375 Issued in IL
Practice address
2323 Grand Ave
Waukegan, IL 60085-3312
Phone
(312) 432-2606
NPI assigned
Feb 8, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209009375 IL
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 209009375 IL Primary

Addresses

Primary practice location

2323 Grand Ave
Waukegan, IL 60085-3312

Mailing address

5360 Conifer LN
Gurnee, IL 60031-6352
Phone (224) 419-8945

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20120606000679 IL Practitioner - Nurse Practitioner 7517121304 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Erie Family Health Center, IncGroup PAC ID 9537050422, 141 clinicians

Practice addresses (Care Compare)

1701 W Superior St
Chicago, IL 60622-5646
Phone (312) 666-3494

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
209009375ILMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Erie Family Health Center, Inc CurrentSince Dec 23, 2021 Accepting new patients
Advocate Health and Hospitals Corporation Current Accepting new patients
Advocate Health & Hospitals Corp. CurrentSince May 16, 2016 Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince May 16, 2016 Accepting new patients
Erie Family Health Center Inc CurrentSince Dec 23, 2021 Accepting new patients

Locations

3 E Golf Rd
Arlington Hts, IL 60005
Phone (800) 323-0358

214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160

1701 W Superior St
Fl 3
Chicago, IL 60622
Phone (312) 432-7381

29373 Network Pl
Chicago, IL 60673

1504 S Albany Ave
Chicago, IL 60623

63 W 87th St
Naperville, IL 60565
Phone (630) 778-7645

2323 Grand Ave
Waukegan, IL 60085
Phone (847) 666-2427

Interoperability endpoints

  • Direct secure messaging: mglover368512@direct.ochin.org

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1328659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670803200000",
    "number": "1497027262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5360 CONIFER LN",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600316352",
            "telephone_number": "224-419-8945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2323 GRAND AVE",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600853312",
            "telephone_number": "312-432-2606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLOVER",
        "first_name": "MARISOL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-08",
        "last_updated": "2022-12-12",
        "certification_date": "2022-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209009375",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "209009375",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukegan, IL

Sources for this page

Verify at the official NPI Registry.