Active NPI
Eileen Conneely, RD,LD, CPT
- Registered Dietitian
- Orland Park, IL
National Provider Identifier
1811424948
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 1033430
- Practice address
- 14711 S Ravinia Ave
Orland Park, IL 60462-3100 - Phone
- (708) 226-0555
- Fax
- (708) 226-0555
- NPI assigned
- May 19, 2017
- Last updated
- May 19, 2017
- 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 1033430 | IL | Primary |
Addresses
Primary practice location
14711 S Ravinia Ave
Orland Park, IL 60462-3100
Mailing address
17612 Mulberry Ave
Tinley Park, IL 60487-7694
Phone (773) 771-4655
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033430 | Other | IL | COMMISSION ON DIETETIC REGISTRATION |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1033430 | IL | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
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": "1495152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1495152000000",
"number": "1811424948",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17612 MULBERRY AVE",
"city": "TINLEY PARK",
"state": "IL",
"postal_code": "604877694",
"telephone_number": "773-771-4655"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14711 S RAVINIA AVE",
"city": "ORLAND PARK",
"state": "IL",
"postal_code": "604623100",
"telephone_number": "708-226-0555",
"fax_number": "708-226-0555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONNEELY",
"first_name": "EILEEN",
"credential": "RD,LD, CPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-05-19",
"last_updated": "2017-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "1033430",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMMISSION ON DIETETIC REGISTRATION",
"identifier": "1033430",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Orland Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 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.