Individual provider Active NPI

Andrew Clavijo, APRN

  • Psychiatric/Mental Health Nurse Practitioner
  • Chicago, IL
National Provider Identifier
1639907512
Registry record updated Jul 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
209030321 Issued in IL
Practice address
4840 N Marine Dr
Chicago, IL 60640-7860
Phone
(773) 878-9700
NPI assigned
Jul 23, 2024
Last updated
Jul 9, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 041489081 IL
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 209030321 IL Primary

Addresses

Primary practice location

4840 N Marine Dr
Chicago, IL 60640-7860

Mailing address

5236 N Virginia Ave
Chicago, IL 60625-4015
Phone (773) 573-8648

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
I20250804003088 IL Practitioner - Nurse Practitioner 0648788349 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Matrix Mental Health LTDGroup PAC ID 6204378714, 10 clinicians

Practice addresses (Care Compare)

1225 Richards St
Joliet, IL 60433-2745
Phone (312) 554-5431

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
041489081ILMDRegistered Nurse
209030321ILMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Matrix Mental Health LTD CurrentSince Jun 14, 2025 Accepting new patients
Sway Behavioral Healthcare P.C. CurrentSince May 18, 2025 Accepting new patients

Locations

111 N Wabash Ave
#3261
Chicago, IL 60602
Phone (312) 278-1859

111 N Wabash Ave
Ste 100
Chicago, IL 60602
Phone (312) 219-1597

1225 Richards St
Joliet, IL 60433
Phone (312) 554-5431

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1721692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752019200000",
    "number": "1639907512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5236 N VIRGINIA AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606254015",
            "telephone_number": "773-573-8648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4840 N MARINE DR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606407860",
            "telephone_number": "773-878-9700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLAVIJO",
        "first_name": "ANDREW",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-07-23",
        "last_updated": "2025-07-09",
        "certification_date": "2025-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041489081",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "209030321",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.