Active NPI
Dehedgra Idowu, AGPCNP-BC
- Gerontology Nurse Practitioner
- Oak Park, IL
National Provider Identifier
1609054881
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gerontology Nurse Practitioner
- License
- 209012233
- Practice address
- 18 Chicago Ave
Oak Park, IL 60302-2402 - Phone
- (773) 253-3933
- Fax
- (773) 437-6780
- NPI assigned
- Feb 9, 2008
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN562570 | PA | |
| Gerontology Nurse Practitioner | 363LG0600X | 209012233 | IL | Primary |
| Medical-Surgical Registered Nurse | 163WM0705X | 041424181 | IL |
Addresses
Primary practice location
18 Chicago Ave
Oak Park, IL 60302-2402
Mailing address
213 N Racine Ave
Chicago, IL 60607-1644
Phone (312) 733-9730
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
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN562570 | PA | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Osh-Il Physicians Group LLC | Current | Accepting new patients | |
| Vpa PC | Current | Accepting new patients | |
| Vpa PC | Current | Accepting new patients | |
| Vpa PC | Current | Accepting new patients |
Locations
4848 W Irving Park Rd
Chicago, IL 60641
Phone (773) 724-6200
18 Chicago Ave
Oak Park, IL 60302
Phone (773) 253-3933
Organizations & group practices 4
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.
-
- Primary Care Clinic/Center
- East Saint Louis, IL
- NPI 1265977698
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1202515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1444867200000",
"number": "1609054881",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "213 N RACINE AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606071644",
"telephone_number": "312-733-9730"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18 CHICAGO AVE",
"city": "OAK PARK",
"state": "IL",
"postal_code": "603022402",
"telephone_number": "773-253-3933",
"fax_number": "773-437-6780"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IDOWU",
"first_name": "DEHEDGRA",
"name_prefix": "Mrs.",
"credential": "AGPCNP-BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-02-09",
"last_updated": "2015-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "PA",
"license": "RN562570",
"primary": false
},
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "IL",
"license": "209012233",
"primary": true
},
{
"code": "163WM0705X",
"taxonomy_group": "",
"desc": "Registered Nurse, Medical-Surgical",
"state": "IL",
"license": "041424181",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oak Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2015; 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.