Active NPI
Anju Mathew Thomas
- Family Nurse Practitioner
- Addison, IL
National Provider Identifier
1528608189
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 209020521
- Practice address
- 715 W Lake St Ste 104
Addison, IL 60101-2082 - Phone
- (630) 366-6681
- NPI assigned
- Jan 13, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 209020521 | IL | Primary |
Addresses
Primary practice location
715 W Lake St Ste 104
Addison, IL 60101-2082
Mailing address
384 Woodside Dr
Wood Dale, IL 60191-2533
Phone (630) 628-1780
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231128002171 | IL | Order and Referring Only - Nurse Practitioner | 8224465836 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1578873600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1647388800000",
"number": "1528608189",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "384 WOODSIDE DR",
"city": "WOOD DALE",
"state": "IL",
"postal_code": "601912533",
"telephone_number": "630-628-1780"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "715 W LAKE ST STE 104",
"city": "ADDISON",
"state": "IL",
"postal_code": "601012082",
"telephone_number": "630-366-6681"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THOMAS",
"first_name": "ANJU",
"middle_name": "MATHEW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-01-13",
"last_updated": "2022-03-16",
"certification_date": "2022-03-16",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "IL",
"license": "209020521",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Addison, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2022; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.