Individual provider Active NPI

Justyna E Pomiotlo, N.P.

  • Family Nurse Practitioner
  • Chicago, IL
National Provider Identifier
1629475546
Registry record updated Apr 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
277.005097 Issued in IL
Practice address
1401 N Western Ave
Chicago, IL 60622-1735
Phone
(708) 292-7000
Fax
(708) 887-5874
NPI assigned
Nov 20, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 28168329A IN
Family Nurse Practitioner 363LF0000X 277.005097 IL Primary
Family Nurse Practitioner 363LF0000X 71005312A IN

Addresses

Primary practice location

1401 N Western Ave
Chicago, IL 60622-1735

Mailing address

PO Box 746715
Atlanta, GA 30374-6715
Phone (708) 292-7000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20150424001311 IN Practitioner - Nurse Practitioner 5698094621 Reassigns benefits to 1 organization
I20230914003565 IL Practitioner - Nurse Practitioner 5698094621 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oak Street Health Physicians Group PCGroup PAC ID 7517109879, 227 clinicians

Practice addresses (Care Compare)

4848 W Irving Park Rd
Chicago, IL 60641-2718
Phone (855) 625-7878

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
277.005097ILMDFamily Nurse Practitioner
71005312AINMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Villagemd Indiana, PC CurrentSince Nov 1, 2021 Accepting new patients
Oak Street Health Physicians Group, PC Family CurrentSince Aug 4, 2023 Accepting new patients

Locations

3046 Burr Oak Ave
Blue Island, IL 60406
Phone (708) 377-7920

1401 N Western Ave
Chicago, IL 60622
Phone (708) 292-7000

4848 W Irving Park Rd
Chicago, IL 60641
Phone (773) 724-6200

6097 Broadway
Merrillville, IN 46410
Phone (219) 758-5152

5495 Broadway
Merrillville, IN 46410
Phone (219) 884-4900

6097 Broadway
Ste 100
Merrillville, IN 46410

22 US Highway 41
Schererville, IN 46375
Phone (219) 865-6472

Organizations & group practices 2

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1416441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775001600000",
    "number": "1629475546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746715",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746715",
            "telephone_number": "708-292-7000",
            "fax_number": "708-887-5874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 N WESTERN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606221735",
            "telephone_number": "708-292-7000",
            "fax_number": "708-887-5874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POMIOTLO",
        "first_name": "JUSTYNA",
        "middle_name": "E",
        "name_prefix": "Ms.",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-11-20",
        "last_updated": "2026-04-01",
        "certification_date": "2026-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "IN",
            "license": "28168329A",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "277.005097",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71005312A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.