Individual provider Active NPI

Nicole Rodriguez

  • Family Nurse Practitioner
  • Hoffman Estates, IL
National Provider Identifier
1740653872
Registry record updated Apr 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209013361 Issued in IL
Practice address
1555 Barrington Rd Ste 2350
Hoffman Estates, IL 60169-5016
Phone
(847) 755-1300
NPI assigned
Nov 11, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2021

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 209013361 IL Primary

Addresses

Primary practice location

1555 Barrington Rd Ste 2350
Hoffman Estates, IL 60169-5016

Mailing address

1555 Barrington Rd Ste 2350
Hoffman Estates, IL 60169-5016
Phone (847) 755-1300

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address nicole.rodriguez.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: 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
I20170811002338 IL Practitioner - Nurse Practitioner 5799056529 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
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

800 Biesterfield Rd
Elk Grove Village, IL 60007-3364

Hospital & facility affiliations

  • St Alexius Medical Center Hospital, Hoffman Estates, IL, CCN 140290
  • Alexian Brothers Medical Center 1 Hospital, Elk Grove Village, IL, CCN 140258
  • Amita Health Resurrection Medical Center Hospital, Chicago, IL, CCN 140117
  • Northwest Community Hospital 1 Hospital, Arlington Heights, IL, CCN 140252

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209013361ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Bonaventure Medical Foundation, LLC CurrentSince Jul 1, 2017 Accepting new patients

Locations

1555 N Barrington Rd
Ste 2350
Hoffman Estates, IL 60169
Phone (847) 230-4428

1555 N Barrington Rd
Ste 515
Hoffman Estates, IL 60169
Phone (224) 412-2156

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

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 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": "1447200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618444800000",
    "number": "1740653872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1555 BARRINGTON RD STE 2350",
            "city": "HOFFMAN ESTATES",
            "state": "IL",
            "postal_code": "601695016",
            "telephone_number": "847-755-1300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 BARRINGTON RD STE 2350",
            "city": "HOFFMAN ESTATES",
            "state": "IL",
            "postal_code": "601695016",
            "telephone_number": "847-755-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-11",
        "last_updated": "2021-04-15",
        "certification_date": "2021-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209013361",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nicole.rodriguez.1@380.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "1555 Barrington Rd Ste 2350",
            "city": "Hoffman Estates",
            "state": "IL",
            "country_code": "US",
            "postal_code": "601695016",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hoffman Estates, IL

Sources for this page

Verify at the official NPI Registry.