Debra D Mangrum, NP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

209015375 Issued in IL

Practice address

3800 W 203Rd St Ste 204
Olympia Fields, IL 60461-1185

Phone

(708) 852-2641

Fax

(708) 503-3260

NPI assigned

Dec 29, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

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

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Specialty Physicians of Illinois LLCGroup PAC ID 4183529456, 114 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Franciscan Health Olympia & Chicago Heights Hospital, Olympia Fields, IL, CCN 140172
• Franciscan Health Dyer Hospital, Dyer, IN, CCN 150090

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Specialty Physicians of Illinois, LLC

  • Internal Medicine Physician
  • Greenwood, IN
  • NPI 1124075676

  IL

  Medicare reassignment Care Compare group NPD
• Prime Healthcare Illinois Medical Group LLC

  • Multi-Specialty Clinic/Center
  • Des Plaines, IL
  • NPI 1023837689
  Medicare reassignment
• Specialty Physicians of Illinois, LLC

  • Urgent Care Clinic/Center
  • Frankfort, IL
  • NPI 1962024612
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Franciscan Health Olympia Fields

  • General Acute Care Hospital
  • Olympia Fields, IL
  • NPI 1588771919
  Care Compare affiliation
• Franciscan Health Dyer & Hammond

  • General Acute Care Hospital
  • Dyer, IN
  • NPI 1811077431
  Care Compare affiliation

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

{
    "created_epoch": "1482969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639526400000",
    "number": "1669917654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35318 EAGLE WAY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606781353",
            "telephone_number": "317-528-4800",
            "fax_number": "317-865-1479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3800 W 203RD ST STE 204",
            "city": "OLYMPIA FIELDS",
            "state": "IL",
            "postal_code": "604611185",
            "telephone_number": "708-852-2641",
            "fax_number": "708-503-3260"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2525 S Michigan Ave Fl 12",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606162315",
            "country_code": "US",
            "telephone_number": "312-567-2380 x4043",
            "fax_number": "312-328-7739",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2525 S Michigan Ave Fl 12",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606162315",
            "country_code": "US",
            "telephone_number": "312-567-2380 x4043",
            "fax_number": "312-328-7739",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANGRUM",
        "first_name": "DEBRA",
        "middle_name": "D",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-12-29",
        "last_updated": "2021-12-15",
        "certification_date": "2021-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IN",
            "license": "71007051A",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IL",
            "license": "209015375",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300024535",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dmangrum248194@Direct.FranciscanAlliance.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "701 Superior Ave Ste J",
            "city": "Munster",
            "state": "IN",
            "country_code": "US",
            "postal_code": "46321",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Aman Luthra, MD
• Samuel L Macagba Jr., MD
• Jazmine Shaynika Mack, OTR/L
• Savio G Manatt, M.D.
• Erin Mangin
• Abdelrahman Ahmed Mansour, DO
• Stephanie Kay Marks
• Athanasios George Marneris, D.O
• Areeba Marrium, MD
• Marsol Enterprises, Inc

• Adult Health Nurse Practitioner in Olympia Fields, IL
• Providers in Olympia Fields, IL by specialty
• Adult Health Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.