Individual provider Active NPI

Emily Anne Martillaro, APRN,CNP

  • Nurse Practitioner
  • Glen Ellyn, IL
National Provider Identifier
1639904006
Registry record updated Oct 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209030724 Issued in IL
Practice address
285 Roosevelt Rd Ste a
Glen Ellyn, IL 60137-5618
Phone
(630) 469-0045
Fax
(630) 469-0645
NPI assigned
Sep 5, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209.030724 IL
Nurse Practitioner 363L00000X 209030724 IL Primary

Addresses

Primary practice location

285 Roosevelt Rd Ste a
Glen Ellyn, IL 60137-5618

Mailing address

285 Roosevelt Rd Ste a
Glen Ellyn, IL 60137-5618
Phone (630) 469-0045

Other practice location 1

0N624 Knollwood Dr
Wheaton, IL 60187-1707
Phone (708) 369-6966

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
I20241028000301 IL Practitioner - Nurse Practitioner 3870026099 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Central Dupage Physician GroupGroup PAC ID 5890696231, 1,087 clinicians

Practice addresses (Care Compare)

285 Roosevelt Rd
Glen Ellyn, IL 60137-5618
Phone (630) 469-0045

Hospital & facility affiliations

  • Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242
  • Northwestern Medicine Delnor Community Hospital Hospital, Geneva, IL, CCN 140211

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209030724ILMDNurse Practitioner
209.030724ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Central Dupage Physician Group CurrentSince Oct 10, 2024 Accepting new patients
Central Dupage Physician Group CurrentSince Oct 10, 2024 Accepting new patients

Locations

Carol Stream, IL 60122
Phone (630) 933-3300

Dept 5777
Carol Stream, IL 60122

285 Roosevelt Rd
Glen Ellyn, IL 60137
Phone (630) 469-0045

285 Roosevelt Rd
Ste A
Glen Ellyn, IL 60137
Phone (630) 469-0045

1800 N Main St
Wheaton, IL 60187
Phone (630) 469-0045

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": "1725494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729123200000",
    "number": "1639904006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "285 ROOSEVELT RD STE A",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601375618",
            "telephone_number": "630-469-0045",
            "fax_number": "630-469-0645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "285 ROOSEVELT RD STE A",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601375618",
            "telephone_number": "630-469-0045",
            "fax_number": "630-469-0645"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "0N624 Knollwood Dr",
            "address_purpose": "LOCATION",
            "city": "Wheaton",
            "state": "IL",
            "postal_code": "601871707",
            "country_code": "US",
            "telephone_number": "708-369-6966",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARTILLARO",
        "first_name": "EMILY",
        "middle_name": "ANNE",
        "credential": "APRN,CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-05",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.030724",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209030724",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Ellyn, IL

Sources for this page

Verify at the official NPI Registry.