Individual provider Active NPI

Miriam Teresa Rodriguez, APN, FNP-C

  • Family Nurse Practitioner
  • Waukegan, IL
National Provider Identifier
1730645912
Registry record updated Jun 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209018657 Issued in IL
Practice address
3210 Grand Ave
Waukegan, IL 60085-2204
Phone
(847) 220-4103
NPI assigned
Feb 13, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 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 209018657 IL Primary

Addresses

Primary practice location

3210 Grand Ave
Waukegan, IL 60085-2204

Mailing address

PO Box 746715
Atlanta, GA 30374-6715
Phone (773) 352-1515

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
I20190402001620 IL Practitioner - Nurse Practitioner 4284975178 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Oak Street Health Physicians Group PCGroup PAC ID 7517109879, 227 clinicians

Practice addresses (Care Compare)

3210 Grand Ave
Waukegan, IL 60085-2204
Phone (847) 220-4103

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209018657ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Oak Street Health Physicians Group, PC Family CurrentSince Oct 21, 2024 Accepting new patients
Erie Family Health Center, Inc Current Accepting new patients
Erie Family Health Center Inc CurrentSince Mar 25, 2019 Accepting new patients
Erie Family Health Center Inc CurrentSince Mar 25, 2019 Accepting new patients
Osh-Il Physicians Group LLC Family PastSince Oct 21, 2024 Accepting new patients

Locations

1701 W Superior St
Chicago, IL 60622
Phone (312) 432-7392

1504 S Albany Ave
Chicago, IL 60623

4848 W Irving Park Rd
Chicago, IL 60641
Phone (773) 724-6200

1701 W Superior St
Fl 3
Chicago, IL 60622
Phone (312) 432-7381

3210 Grand Ave
Waukegan, IL 60085
Phone (847) 220-4103

2323 Grand Ave
Waukegan, IL 60085
Phone (847) 666-2427

Organizations & group practices 5

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 5

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": "1550016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749081600000",
    "number": "1730645912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746715",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746715",
            "telephone_number": "773-352-1515",
            "fax_number": "312-929-0373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3210 GRAND AVE",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600852204",
            "telephone_number": "847-220-4103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "MIRIAM",
        "middle_name": "TERESA",
        "credential": "APN, FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-13",
        "last_updated": "2025-06-05",
        "certification_date": "2025-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209018657",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukegan, IL

Sources for this page

Verify at the official NPI Registry.