NPIMap

Organization Active NPI

Livestrong Medical PLLC

  • Nurse Practitioner
  • Mokena, IL
National Provider Identifier
1710799788
Registry record updated Jan 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
LIVESTRONG MEDICAL PLLC
Practice address
9019 Willow LN
Mokena, IL 60448-8374
Phone
(708) 691-4890
NPI assigned
Jan 24, 2025
Last updated
Jan 24, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2025

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

Authorized official

Name
Jessica Sue KotNPI 1568973956
Title
Owner
Phone
(708) 691-4890

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X Primary

Addresses

Primary practice location

9019 Willow LN
Mokena, IL 60448-8374

Mailing address

9019 Willow LN
Mokena, IL 60448-8374

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250130000715 IL Part B Supplier - Clinic/Group Practice 3476082850 Receives reassigned benefits from 17 practitioners
Practice locations: Mokena, IL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1737676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737676800000",
    "number": "1710799788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9019 WILLOW LN",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604488374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9019 WILLOW LN",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604488374",
            "telephone_number": "708-691-4890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVESTRONG MEDICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-24",
        "last_updated": "2025-01-24",
        "certification_date": "2025-01-24",
        "status": "A",
        "authorized_official_last_name": "KOT",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "708-691-4890"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mokena, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.