Individual provider Active NPI

Xiomara Nieto, FNP

  • Family Nurse Practitioner
  • Chicago, IL
National Provider Identifier
1619476116
Registry record updated Jul 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209.016080 Issued in IL
Practice address
4070 N Milwaukee Ave
Chicago, IL 60641-1831
Phone
(312) 374-6104
NPI assigned
Feb 9, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209.016080 IL Primary

Addresses

Primary practice location

4070 N Milwaukee Ave
Chicago, IL 60641-1831

Mailing address

5433 W Agatite Ave
Chicago, IL 60630-3501
Phone (773) 430-3359

Other names 1

  • Xiomara Pivaral Former name

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
I20190417000547 IL Practitioner - Nurse Practitioner 6507107794 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Midwest Express Care 2, IncGroup PAC ID 0547495467, 221 clinicians

Practice addresses (Care Compare)

40 75TH St
Willowbrook, IL 60527-2325
Phone (630) 581-5372

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209.016080ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Express Care 2, Inc CurrentSince Jan 15, 2020 Accepting new patients
Infant Welfare Society of Chicago CurrentSince Apr 1, 2019 Accepting new patients
Midwest Express Care 2, Inc CurrentSince Jan 15, 2020 Accepting new patients

Locations

12200 Western Ave
Blue Island, IL 60406
Phone (630) 581-5372

4070 N Milwaukee Ave
Chicago, IL 60641
Phone (312) 374-6104

3600 W Fullerton Ave
Chicago, IL 60647
Phone (773) 782-2800

40 75th St
Willowbrook, IL 60527
Phone (630) 326-5312

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1518134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689811200000",
    "number": "1619476116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5433 W AGATITE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606303501",
            "telephone_number": "773-430-3359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4070 N MILWAUKEE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606411831",
            "telephone_number": "312-374-6104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIETO",
        "first_name": "XIOMARA",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-09",
        "last_updated": "2023-07-20",
        "certification_date": "2023-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.016080",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "XIOMARA",
            "last_name": "PIVARAL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.