Individual provider Active NPI

Kesha Douglas-Jackson, APN

  • Family Nurse Practitioner
  • Maywood, IL
National Provider Identifier
1720598071
Registry record updated Oct 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209016670 Issued in IL
Practice address
2160 S 1St Ave
Maywood, IL 60153-3328
Phone
(872) 231-3162
Fax
(708) 795-0101
NPI assigned
Oct 1, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 8, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209016670 IL Primary

Addresses

Primary practice location

2160 S 1St Ave
Maywood, IL 60153-3328

Mailing address

PO Box 74008272
Chicago, IL 60674-8272
Phone (702) 899-0595

Other identifiers 1

IdentifierTypeStateIssuer
041410556OtherILREGISTERED NURSE

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
I20180116001967 IL Practitioner - Nurse Practitioner 8820357031 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Integrated Rehab Consultants LLCGroup PAC ID 7810184892, 162 clinicians

Practice addresses (Care Compare)

1415 W Foster Ave
Chicago, IL 60640-2288
Phone (773) 769-5500

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.28 of 100Reported as group
Quality
73.83
Improvement activities
40
Cost
45.57

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Integrated Rehab Consultants LLC CurrentSince Jul 1, 2020 Accepting new patients
Integrated Rehab Consultants LLC CurrentSince Jul 1, 2020 Accepting new patients

Locations

111 E Washington St
Bensenville, IL 60106
Phone (630) 521-8012

3249 Oak Park Ave
Berwyn, IL 60402
Phone (708) 783-2696

2451 W Touhy Ave
Chicago, IL 60645
Phone (312) 593-5599

1415 W Foster Ave
Chicago, IL 60640
Phone (630) 307-9617

4646 N Marine Dr
Chicago, IL 60640
Phone (773) 564-5102

2450 N Central Ave
Chicago, IL 60639
Phone (773) 889-1333

1725 S Wabash Ave
Chicago, IL 60616
Phone (312) 842-4400

2525 S Michigan Ave
Chicago, IL 60616
Phone (312) 355-1153

401 N Michigan Ave
Ste 1200
Chicago, IL 60611
Phone (224) 496-6940

1040 Robey Ave
Downers Grove, IL 60516
Phone (630) 969-9188

1760 Capital St
Elgin, IL 60124
Phone (847) 531-6004

420 W Butterfield Rd
Elmhurst, IL 60126
Phone (630) 832-2300

2000 W Lake St
Hanover Park, IL 60133
Phone (224) 456-6662

2160 S 1st Ave
Maywood, IL 60153
Phone (708) 216-4400

701 W North Ave
Melrose Park, IL 60160
Phone (708) 450-5779

3 Erie Ct
Oak Park, IL 60302
Phone (708) 763-6200

2406 Hartland Rd
Woodstock, IL 60098
Phone (815) 338-0312

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 3

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": "1506816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759881600000",
    "number": "1720598071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 74008272",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606748272",
            "telephone_number": "702-899-0595",
            "fax_number": "702-977-1496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 S 1ST AVE",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601533328",
            "telephone_number": "872-231-3162",
            "fax_number": "708-795-0101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS-JACKSON",
        "first_name": "KESHA",
        "credential": "APN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-10-01",
        "last_updated": "2025-10-08",
        "certification_date": "2025-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209016670",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGISTERED NURSE",
            "identifier": "041410556",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maywood, IL

Sources for this page

Verify at the official NPI Registry.