Individual provider Active NPI

Carolyn Sehlbrede Banner, RD, LDN

  • Registered Dietitian
  • Chicago, IL
National Provider Identifier
1619065216
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
Practice address
1531 E Hyde Park Blvd
University of Chicago Hospitals Lake Park Dialysis Unit
Chicago, IL 60615-3039
Phone
(773) 702-4548
Fax
(773) 702-3565
NPI assigned
Oct 10, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X IL Primary

Addresses

Primary practice location

1531 E Hyde Park Blvd
University of Chicago Hospitals Lake Park Dialysis Unit
Chicago, IL 60615-3039

Mailing address

5110 S Hyde Park Blvd
Apt 3a
Chicago, IL 60615-4272
Phone (773) 702-4548

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
164.004075ILMDRegistered Dietitian

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619065216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5110 S HYDE PARK BLVD",
            "address_2": "APT 3A",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606154272",
            "telephone_number": "773-702-4548",
            "fax_number": "773-702-3565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1531 E HYDE PARK BLVD",
            "address_2": "UNIVERSITY OF CHICAGO HOSPITALS LAKE PARK DIALYSIS UNIT",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606153039",
            "telephone_number": "773-702-4548",
            "fax_number": "773-702-3565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANNER",
        "first_name": "CAROLYN",
        "middle_name": "SEHLBREDE",
        "credential": "RD, LDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.