Active NPI
Jeanna Carlson, FNP
- Family Nurse Practitioner
- Chicago, IL
National Provider Identifier
1659739357
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 209011885
- Practice address
- 211 E Grand Ave FL 6
Chicago, IL 60611-3311 - Phone
- (312) 229-0170
- Fax
- (312) 600-9072
- NPI assigned
- Feb 9, 2016
- Last updated
- Sep 28, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 209011885 | IL | Primary |
Addresses
Primary practice location
211 E Grand Ave FL 6
Chicago, IL 60611-3311
Mailing address
211 E Grand Ave FL 6
Chicago, IL 60611-3311
Phone (312) 229-0170
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209011885 | IL | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dominican University Wellness Center | Past | Accepting new patients | |
| Lurie Children's Medical Group, LLC | Past | Accepting new patients |
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.
-
dba Wellness Center
- Student Health Clinic/Center
- River Forest, IL
- NPI 1477892446
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1454976000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632787200000",
"number": "1659739357",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "211 E GRAND AVE FL 6",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606113311",
"telephone_number": "312-229-0170",
"fax_number": "312-600-9072"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "211 E GRAND AVE FL 6",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606113311",
"telephone_number": "312-229-0170",
"fax_number": "312-600-9072"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLSON",
"first_name": "JEANNA",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-02-09",
"last_updated": "2021-09-28",
"certification_date": "2021-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "IL",
"license": "209011885",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 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.