Ma Vanessa S Mabazza, APRN,NP-C,AGPCNP-BC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

209017671 Issued in IL

Practice address

2550 Hauser Ross Drive
Suite 350
Sycamore, IL 60178

Phone

(815) 758-7700

Fax

(815) 756-6103

NPI assigned

May 21, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mmabazza288515@direct.myadvocateaurora.org

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.

• Elite Cardiology Solutions LLC

  • Specialist
  • Sycamore, IL
  • NPI 1740428184
  Medicare reassignment NPD

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

{
    "created_epoch": "1526860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639526400000",
    "number": "1780175380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2550 HAUSER ROSS DR STE 350",
            "city": "SYCAMORE",
            "state": "IL",
            "postal_code": "601783181",
            "telephone_number": "815-758-7700",
            "fax_number": "815-756-6103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2550 HAUSER ROSS DRIVE",
            "address_2": "SUITE 350",
            "city": "SYCAMORE",
            "state": "IL",
            "postal_code": "60178",
            "telephone_number": "815-758-7700",
            "fax_number": "815-756-6103"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 N McLean Blvd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Elgin",
            "state": "IL",
            "postal_code": "601233275",
            "country_code": "US",
            "telephone_number": "224-535-9922",
            "fax_number": "224-856-5363",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MABAZZA",
        "first_name": "MA VANESSA",
        "middle_name": "S",
        "credential": "APRN,NP-C,AGPCNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-21",
        "last_updated": "2021-12-15",
        "certification_date": "2021-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209017671",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emilie Frances Lothson
• Elizabeth Lowe, MA
• Jeff Yasin Lu, DDS
• Melissa Maria Lugo, PEL, LPC, NCC
• M I M Hematology-Oncology LLC
• Dana Macklin, LCSW
• Ryanne Christine Madden, MA SLP
• Sara Madrid
• Jacinthe Ventura Malalis, D.O.
• Wendell R Malalis, M.D.

• Nurse Practitioner in Sycamore, IL
• Providers in Sycamore, IL by specialty
• Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.