Individual provider Active NPI

Jennifer L Calderala, APRN, CNP

  • Nurse Practitioner
  • Dekalb, IL
National Provider Identifier
1720476963
Registry record updated May 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209011970 Issued in IL
Practice address
626 Bethany Rd
Dekalb, IL 60115-4939
Phone
(815) 306-2700
Fax
(815) 306-2715
NPI assigned
Dec 22, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 041376559 IL
Nurse Practitioner 363L00000X 209011970 IL Primary

Addresses

Primary practice location

626 Bethany Rd
Dekalb, IL 60115-4939

Mailing address

626 Bethany Rd
Dekalb, IL 60115-4939
Phone (815) 306-2700

Other names 1

  • Jennifer John Former name

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20220520002115 IL Practitioner - Nurse Practitioner 2365716917 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Central Dupage Physician GroupGroup PAC ID 5890696231, 1,087 clinicians

Practice addresses (Care Compare)

626 Bethany Rd
Dekalb, IL 60115-4939
Phone (815) 758-0000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.63 of 100Reported as apm
Quality
88.47
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
041376559ILMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Central Dupage Physician Group CurrentSince Mar 23, 2022 Accepting new patients
Central Dupage Physician Group CurrentSince Mar 23, 2022 Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

Carol Stream, IL 60122
Phone (630) 933-3300

626 Bethany Rd
DeKalb, IL 60115
Phone (815) 306-2700

1800 N Main St
Wheaton, IL 60187
Phone (630) 469-0045

Interoperability endpoints

  • Direct secure messaging: jennifer.calderala.p1@direct.gefcc.nextgenshare.com

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 and National Provider Directory roles.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1419206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652659200000",
    "number": "1720476963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "626 BETHANY RD",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601154939",
            "telephone_number": "815-306-2700",
            "fax_number": "815-306-2715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "626 BETHANY RD",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601154939",
            "telephone_number": "815-306-2700",
            "fax_number": "815-306-2715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CALDERALA",
        "first_name": "JENNIFER",
        "middle_name": "L",
        "credential": "APRN, CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-22",
        "last_updated": "2022-05-16",
        "certification_date": "2022-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041376559",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209011970",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "JOHN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Dekalb, IL

Sources for this page

Verify at the official NPI Registry.