Active NPI
Emily Davis
- Nurse Practitioner
- Chicago, IL
National Provider Identifier
1811415342
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 209016460
- Practice address
- 4417 W Diversey Ave
Chicago, IL 60639 - Phone
- (773) 377-7736
- Fax
- (815) 642-5723
- NPI assigned
- Sep 5, 2017
- Last updated
- Oct 1, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 209016460 | IL | Primary |
Addresses
Primary practice location
4417 W Diversey Ave
Chicago, IL 60639
Mailing address
PO Box 746721
Atlanta, GA 30374-6721
Phone (312) 733-9730
Other practice location 1
1600 Dempster St Ste 120
Park Ridge, IL 60068-1171
Phone (847) 299-7888
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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Oak Street Health Physicians Group, PC | Nurse Practitioner | Current | Accepting new patients |
| Academic & Clinical Associates in Dermatology LTD | Past | Accepting new patients |
Locations
4848 W Irving Park Rd
Chicago, IL 60641
Phone (773) 724-6200
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.
-
- Primary Care Clinic/Center
- Chicago, IL
- NPI 1083051643
Nurse Practitioner
-
- Dermatology Physician
- Oak Park, IL
- NPI 1497972418
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1504569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1601510400000",
"number": "1811415342",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 746721",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303746721",
"telephone_number": "312-733-9730",
"fax_number": "773-866-8014"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4417 W DIVERSEY AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60639",
"telephone_number": "773-377-7736",
"fax_number": "815-642-5723"
}
],
"practiceLocations": [
{
"address_1": "1600 Dempster St Ste 120",
"address_purpose": "LOCATION",
"city": "Park Ridge",
"state": "IL",
"postal_code": "600681171",
"country_code": "US",
"telephone_number": "847-299-7888",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DAVIS",
"first_name": "EMILY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-09-05",
"last_updated": "2020-10-01",
"certification_date": "2020-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "IL",
"license": "209016460",
"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 Oct 1, 2020; 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.