Individual provider Active NPI

Andrea C Rorabaugh, FNP-BC

  • Family Nurse Practitioner
  • Manteno, IL
National Provider Identifier
1780356782
Registry record updated Dec 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
277003647 Issued in IL
Practice address
10454 N 500E Rd
Manteno, IL 60950-3116
Phone
(815) 693-5962
Fax
(815) 989-0144
NPI assigned
Sep 29, 2021
Last updated
Dec 3, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 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 277003647 IL Primary

Addresses

Primary practice location

10454 N 500E Rd
Manteno, IL 60950-3116

Mailing address

10454 N 500E Rd
Manteno, IL 60950-3116
Phone (815) 693-5962

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
I20211209002122 IL Practitioner - Nurse Practitioner 8123418993 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
277003647ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Express Care 2, Inc CurrentSince Nov 29, 2021 Accepting new patients
Midwest Express Care 2, Inc CurrentSince Nov 29, 2021 Accepting new patients

Locations

12200 Western Ave
Blue Island, IL 60406
Phone (630) 581-5372

40 75th St
Willowbrook, IL 60527
Phone (630) 326-5312

40 75th St
Ste 100
Willowbrook, IL 60527

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1632873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764720000000",
    "number": "1780356782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10454 N 500E RD",
            "city": "MANTENO",
            "state": "IL",
            "postal_code": "609503116",
            "telephone_number": "815-693-5962",
            "fax_number": "815-989-0144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10454 N 500E RD",
            "city": "MANTENO",
            "state": "IL",
            "postal_code": "609503116",
            "telephone_number": "815-693-5962",
            "fax_number": "815-989-0144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RORABAUGH",
        "first_name": "ANDREA",
        "middle_name": "C",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-29",
        "last_updated": "2025-12-03",
        "certification_date": "2025-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "277003647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manteno, IL

Sources for this page

Verify at the official NPI Registry.