Individual provider Active NPI

Mary Rose Mabbagu, APN-CNP

  • Nurse Practitioner
  • Skokie, IL
National Provider Identifier
1790422780
Registry record updated Apr 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209026004 Issued in IL
Practice address
9933 Woods Dr
Skokie, IL 60077-1049
Phone
(847) 663-8060
NPI assigned
May 19, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 10, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209.026004 IL
Nurse Practitioner 363L00000X 209026004 IL Primary

Addresses

Primary practice location

9933 Woods Dr
Skokie, IL 60077-1049

Mailing address

9933 Woods Dr
Skokie, IL 60077-1049
Phone (847) 663-8060

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
I20221221002283 IL Practitioner - Nurse Practitioner 6305216052 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Endeavor Health Medical GroupGroup PAC ID 2163334699, 3,330 clinicians

Practice addresses (Care Compare)

1000 Central St
Evanston, IL 60201-1780

1535 Ellinwood Ave
Des Plaines, IL 60016-4553
Phone (224) 364-2273

211 Waukegan Rd
Suite 200
Northfield, IL 60093-2724
Phone (847) 767-3718

225 N Milwaukee Ave
Vernon Hills, IL 60061-4304
Phone (847) 941-7600

2650 Ridge Ave
Evanston, IL 60201-1700

9600 Gross Point Rd
Skokie, IL 60076-1214

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209026004ILMDNurse Practitioner
209.026004ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Endeavor Health Medical Group CurrentSince Jun 25, 2023 Accepting new patients
Endeavor Health Medical Group CurrentSince Jun 25, 2023 Accepting new patients
Accumed Center, S.C. CurrentSince Oct 1, 2022 Accepting new patients

Locations

2010 S Arlington Heights Rd
Ste 209
Arlington Heights, IL 60005
Phone (847) 259-8777

1614 W Central Rd
Ste 209
Arlington Hts, IL 60005
Phone (847) 259-5070

385 Bartlett Plz
Bartlett, IL 60103
Phone (630) 289-6024

9532 Eagle Way
Chicago, IL 60678

2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

9933 Woods Dr
Skokie, IL 60077
Phone (847) 663-8060

Organizations & group practices 3

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 1

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": "1652918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775779200000",
    "number": "1790422780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9933 WOODS DR",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600771049",
            "telephone_number": "847-663-8060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9933 WOODS DR",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600771049",
            "telephone_number": "847-663-8060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MABBAGU",
        "first_name": "MARY ROSE",
        "credential": "APN-CNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-05-19",
        "last_updated": "2026-04-10",
        "certification_date": "2026-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.026004",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209026004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Skokie, IL

Sources for this page

Verify at the official NPI Registry.