Ma Teresa Datoon Panganiban, NURSE PRACTITIONER

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

209020448 Issued in IL

Practice address

1920 Aspen LN
Glendale Heights, IL 60139-2139

Phone

(630) 965-3354

NPI assigned

Aug 13, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Reliable Visiting Physicians Inc

  • General Practice Physician
  • Des Plaines, IL
  • NPI 1578064077
  NPD

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

{
    "created_epoch": "1628812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628812800000",
    "number": "1558036293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1920 ASPEN LN",
            "city": "GLENDALE HEIGHTS",
            "state": "IL",
            "postal_code": "601392139",
            "telephone_number": "630-965-3354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1920 ASPEN LN",
            "city": "GLENDALE HEIGHTS",
            "state": "IL",
            "postal_code": "601392139",
            "telephone_number": "630-965-3354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANGANIBAN",
        "first_name": "MA TERESA",
        "middle_name": "DATOON",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-13",
        "last_updated": "2021-08-13",
        "certification_date": "2021-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "IL",
            "license": "209020448",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Rose Supetran Ong-Perez, RN
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• Osama Ismail D.D.S.
• Dyanna Ishtar Pacheco, RBT-17-31942
• Rincy Panicker, PA-C
• Nirali Ritesh Parikh, M.D.
• Roshni Parikh, PHARM.D
• Genna Parise
• Biren Patel, OD

• All providers in Glendale Heights, IL
• Primary Care Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2021; 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.

Verify at the official NPI Registry.