Individual provider Active NPI

Shruti Patel, FNP-BC

  • Family Nurse Practitioner
  • Chicago, IL
National Provider Identifier
1780121848
Registry record updated Jan 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
041.412593 Issued in IL
Practice address
3055 N Menard Ave
Chicago, IL 60634-5221
Phone
(773) 701-1999
NPI assigned
Jan 27, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2017

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 041.412593 IL Primary

Addresses

Primary practice location

3055 N Menard Ave
Chicago, IL 60634-5221

Mailing address

3055 N Menard Ave
Chicago, IL 60634-5221
Phone (773) 701-1999

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
041.412593ILMDFamily Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1485475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485475200000",
    "number": "1780121848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3055 N MENARD AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606345221",
            "telephone_number": "773-701-1999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3055 N MENARD AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606345221",
            "telephone_number": "773-701-1999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATEL",
        "first_name": "SHRUTI",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-27",
        "last_updated": "2017-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "041.412593",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.