Individual provider Active NPI

Caroline Haughey Dubord, APRN

  • Nurse Practitioner
  • Chicago, IL
National Provider Identifier
1528549474
Registry record updated Dec 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209.018088 Issued in IL
Practice address
675 N Saint Clair St Ste 19-250
Chicago, IL 60611-5964
Phone
(312) 695-6022
Fax
(312) 695-5672
NPI assigned
Aug 28, 2018
Last updated
Dec 28, 2019By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 28, 2019

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 041429204 IL
Plastic Surgery Registered Nurse 163WS0121X 041429204 IL
Adult Health Nurse Practitioner 363LA2200X 209.018088 IL
Nurse Practitioner 363L00000X 209.018088 IL Primary

Addresses

Primary practice location

675 N Saint Clair St Ste 19-250
Chicago, IL 60611-5964

Mailing address

675 N Saint Clair St Ste 19-250
Chicago, IL 60611-5964
Phone (312) 695-6022

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
I20181022001018 IL Practitioner - Nurse Practitioner 9537412556 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
95.19 of 100Reported as apm
Quality
83.05
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
041429204ILMDPlastic Surgery Registered Nurse
209.018088ILMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince Nov 15, 2018 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Nov 15, 2018 Accepting new patients
Central Dupage Physician Group Past Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

259 E Erie St
Ste 2060
Chicago, IL 60611
Phone (312) 695-6022

675 N Saint Clair St
Ste 19-250
Chicago, IL 60611
Phone (312) 694-2428

675 N Saint Clair St
Ste 20250
Chicago, IL 60611

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

Organizations & group practices 3

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": "1535414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577491200000",
    "number": "1528549474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 N SAINT CLAIR ST STE 19-250",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606115964",
            "telephone_number": "312-695-6022",
            "fax_number": "312-695-5672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 N SAINT CLAIR ST STE 19-250",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606115964",
            "telephone_number": "312-695-6022",
            "fax_number": "312-695-5672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUBORD",
        "first_name": "CAROLINE",
        "middle_name": "HAUGHEY",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-28",
        "last_updated": "2019-12-28",
        "certification_date": "2019-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041429204",
            "primary": false
        },
        {
            "code": "163WS0121X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Plastic Surgery",
            "state": "IL",
            "license": "041429204",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IL",
            "license": "209.018088",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209.018088",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.