Libin Manuel Zevallos, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209.022777 Issued in IL

Practice address

4952 W Irving Park Rd
Suite 300
Chicago, IL 60641-2640

Phone

(773) 942-6141

Fax

(847) 672-4799

NPI assigned

Jan 17, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Libin Manuel Zevallos Quinonez Former name

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: libin.zevallos.1@4283.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/4283/brand/1/csg/1/fhir/r4

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.

• Grand Vein Specialists LLC

  • Family Medicine Physician
  • Chicago, IL
  • NPI 1255603247
  Medicare reassignment NPD

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

{
    "created_epoch": "1452988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611878400000",
    "number": "1649637976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4952 W IRVING PARK RD",
            "address_2": "SUITE 300",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606412640",
            "telephone_number": "773-942-6141",
            "fax_number": "847-672-4799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4952 W IRVING PARK RD",
            "address_2": "SUITE 300",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606412640",
            "telephone_number": "773-942-6141",
            "fax_number": "847-672-4799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZEVALLOS",
        "first_name": "LIBIN",
        "middle_name": "MANUEL",
        "name_prefix": "Mr.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-01-17",
        "last_updated": "2021-01-29",
        "certification_date": "2021-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041.473317",
            "primary": false
        },
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "IL",
            "license": "238.000480",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.022777",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LIBIN",
            "last_name": "ZEVALLOS QUINONEZ",
            "middle_name": "MANUEL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Zest Health, LLC
• Joaquin Zetina Huesca, MD
• Adriana Zetina
• Leonid Zetser, MD
• Anna Zettel, PSY.D.
• Zevin and Madej-Zevin M.D. S.C.
• Robert Jay Zevin, MD
• Lily Zexter, MD
• Michelle Lee Zgarrick, PHARM.D.
• Crystal Emmaline Zgela, M.S., CCC-SLP, LSLS

• Family Nurse Practitioner in Chicago, IL
• Providers in Chicago, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.