Individual provider Active NPI

Lullete Tiu Camara, APRN

  • Primary Care Nurse Practitioner
  • Crystal Lake, IL
National Provider Identifier
1639047392
Registry record updated Oct 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
209033677 Issued in IL
Practice address
365 Millennium Dr Ste D
Crystal Lake, IL 60012-3747
Phone
(815) 301-4034
Fax
(815) 301-4035
NPI assigned
Oct 24, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 27, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X 209033677 IL Primary
Home Health Registered Nurse 163WH0200X 041307554 IL

Addresses

Primary practice location

365 Millennium Dr Ste D
Crystal Lake, IL 60012-3747

Mailing address

6617 Majestic Way
Carpentersville, IL 60110-3439
Phone (815) 301-4034

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
I20251117002771 IL Practitioner - Nurse Practitioner 9537115373 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Jet Healthcare LLCGroup PAC ID 1456781889, 20 clinicians

Practice addresses (Care Compare)

5979 Nebeshone LN
Rockford, IL 61103-8926

811 W 2ND St
Byron, IL 61010-1464
Phone (815) 234-2511

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
041307554ILMDHome Health Registered Nurse
209033677ILMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Jet Healthcare LLC CurrentSince Oct 27, 2025 Accepting new patients
Renew Wound Care of Illinois PLLC CurrentSince Dec 9, 2025 Accepting new patients
Care Solutions, Inc. CurrentSince Mar 10, 2004 Accepting new patients

Locations

365 Millennium Dr
Ste D
Crystal Lake, IL 60012
Phone (815) 301-4034

1481 McDonald Ave
Brooklyn, NY 11230
Phone (347) 479-1110

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Care Solutions, Inc.Crystal Lake, IL, CCN 147855 Home health agency Corporate Director
W-2 Managing Employee
Operational/Managerial Control
Mar 10, 2004
Mar 10, 2004
Mar 10, 2004

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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": "1761264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761523200000",
    "number": "1639047392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6617 MAJESTIC WAY",
            "city": "CARPENTERSVILLE",
            "state": "IL",
            "postal_code": "601103439",
            "telephone_number": "815-301-4034",
            "fax_number": "815-301-4035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "365 MILLENNIUM DR STE D",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600123747",
            "telephone_number": "815-301-4034",
            "fax_number": "815-301-4035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMARA",
        "first_name": "LULLETE",
        "middle_name": "TIU",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-10-24",
        "last_updated": "2025-10-27",
        "certification_date": "2025-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "IL",
            "license": "209033677",
            "primary": true
        },
        {
            "code": "163WH0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Home Health",
            "state": "IL",
            "license": "041307554",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crystal Lake, IL

Sources for this page

Verify at the official NPI Registry.