Individual provider Active NPI

Molly Jean Grant, RN, MSN, CPNP

  • Pediatric Nurse Practitioner
  • Chicago, IL
National Provider Identifier
1639358914
Registry record updated Jan 2, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
209003801 Issued in IL
Practice address
2211 N Oak Park Ave
Shriners Hospital
Chicago, IL 60707-3351
Phone
(773) 385-5804
Fax
(773) 385-5488
NPI assigned
Nov 2, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 209003801 IL Primary

Addresses

Primary practice location

2211 N Oak Park Ave
Shriners Hospital
Chicago, IL 60707-3351

Mailing address

2211 N Oak Park Ave
Shriners Hospital
Chicago, IL 60707-3351
Phone (773) 385-5804

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
I20131016000197 IL Practitioner - Nurse Practitioner 6305897547 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Pediatric Nurse Practitioner, Master of Science - Nursing, Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
209003801ILMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Shriners Hospitals for Children CurrentSince Jan 1, 2012 Accepting new patients
Shriners Hospitals for Children CurrentSince Jan 1, 2012 Accepting new patients
Shriners Hospitals for Children Past Accepting new patients

Locations

2211 N Oak Park Ave
Chicago, IL 60707
Phone (773) 385-5463

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": "1193961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1357084800000",
    "number": "1639358914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2211 N OAK PARK AVE",
            "address_2": "SHRINERS HOSPITAL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "607073351",
            "telephone_number": "773-385-5804",
            "fax_number": "773-385-5488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2211 N OAK PARK AVE",
            "address_2": "SHRINERS HOSPITAL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "607073351",
            "telephone_number": "773-385-5804",
            "fax_number": "773-385-5488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANT",
        "first_name": "MOLLY",
        "middle_name": "JEAN",
        "name_prefix": "Mrs.",
        "credential": "RN, MSN, CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-02",
        "last_updated": "2013-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IL",
            "license": "209003801",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.