Laura Jean Fountain, CPNP-PC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

209.018082 Issued in IL

Practice address

225 E Chicago Ave
Chicago, IL 60611-2991

Phone

(312) 227-4000

NPI assigned

Feb 1, 2017

Last updated

Nov 19, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

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.

• Lurie Children's Medical Group Inc

  dba LCMG Inc

  • Pediatrics Physician
  • Chicago, IL
  • NPI 1518064716
  Medicare reassignment NPD
• Lurie Children's Medical Group, LLC

  dba LCMG

  • Pediatrics Physician
  • Chicago, IL
  • NPI 1992758544
  NPD (past)
• Primecare Pediatrics, P.C.

  dba Primecare Pediatrics

  • Pediatrics Physician
  • Newnan, GA
  • NPI 1396905907
  NPD (past)

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

{
    "created_epoch": "1485907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542585600000",
    "number": "1699213496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 E PEARSON ST APT 2407",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606117367",
            "telephone_number": "954-557-3246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 E CHICAGO AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112991",
            "telephone_number": "312-227-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15 Baynard Park",
            "address_purpose": "LOCATION",
            "city": "Newnan",
            "state": "GA",
            "postal_code": "302656413",
            "country_code": "US",
            "telephone_number": "770-251-5253",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3400 Old Milton Pkwy",
            "address_purpose": "LOCATION",
            "city": "Alpharetta",
            "state": "GA",
            "postal_code": "300053707",
            "country_code": "US",
            "telephone_number": "770-751-6111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FOUNTAIN",
        "first_name": "LAURA",
        "middle_name": "JEAN",
        "name_prefix": "Ms.",
        "credential": "CPNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-02-01",
        "last_updated": "2018-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "GA",
            "license": "RN250573",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IL",
            "license": "209.018082",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Foundations Chicago, LLC
• Fountain of Health Home Health Agency LLC
• Fountain Psychotherapy & Consultation, PLLC
• John Wesley Fountain III, MSW
• Krystal Lynnette Fountain
• Samantha Fountain
• Ioannis Kyriakos Fountas, PHARMD
• Four Flowers Wellness
• Four on the Floor
• Four Seasons Dental Studio

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2018; 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.