NPIMap

Individual provider Active NPI

Tiffany Jessica Diaz, M.D.

  • Family Medicine Physician
  • Schaumburg, IL
National Provider Identifier
1730403387
Registry record updated Apr 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036.131493 Issued in IL
Practice address
25 E Schaumburg Rd
Suite 200
Schaumburg, IL 60194-3550
Phone
(847) 985-9390
NPI assigned
Mar 24, 2010
Last updated
Apr 1, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 036.131493 IL Primary

Addresses

Primary practice location

25 E Schaumburg Rd
Suite 200
Schaumburg, IL 60194-3550

Mailing address

25 E Schaumburg Rd
Suite 200
Schaumburg, IL 60194-3550

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tiffany.diaz.1@380.direct.athenahealth.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130802000192 IL Practitioner - Family Practice 4789825712 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Bonaventure Medical Foundation LLCGroup PAC ID 7517863178, 164 clinicians

Practice addresses (Care Compare)

1786 Moon Lake Blvd
Hoffman Est, IL 60194-5029
Phone (847) 755-8208

25 E Schaumburg Rd
Schaumburg, IL 60194-3550
Phone (847) 985-9390

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036.131493ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bonaventure Medical Foundation, LLC Family Medicine CurrentSince Aug 1, 2013 Accepting new patients

Locations

1786 Moon Lake Blvd
Hoffman Estates, IL 60169
Phone (847) 640-5640

25 E Schaumburg Rd
Schaumburg, IL 60194
Phone (847) 985-9390

25 E Schaumburg Rd
Ste 200
Schaumburg, IL 60194
Phone (847) 980-9390

190 W Irving Park Rd
Wood Dale, IL 60191
Phone (630) 766-0412

Organizations & group practices 1

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.

Hospital & facility affiliations 6

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": "1269388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617235200000",
    "number": "1730403387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 E SCHAUMBURG RD",
            "address_2": "SUITE 200",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601943550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 E SCHAUMBURG RD",
            "address_2": "SUITE 200",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601943550",
            "telephone_number": "847-985-9390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIAZ",
        "first_name": "TIFFANY",
        "middle_name": "JESSICA",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-24",
        "last_updated": "2021-04-01",
        "certification_date": "2021-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036.131493",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tiffany.diaz.1@380.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "25 E Schaumburg Rd",
            "address_2": "Suite 200",
            "city": "Schaumburg",
            "state": "IL",
            "country_code": "US",
            "postal_code": "601943550",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Schaumburg, IL

Sources for this page

Verify at the official NPI Registry.