Individual provider Active NPI

Michelle Dela Pena, APRN, FNP

  • Family Nurse Practitioner
  • Naperville, IL
National Provider Identifier
1811518178
Registry record updated Apr 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209.021220 Issued in IL
Practice address
1560 Wall St Ste 304
Naperville, IL 60563-1262
Phone
(630) 416-8289
NPI assigned
Apr 28, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2020

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 209.021220 IL Primary

Addresses

Primary practice location

1560 Wall St Ste 304
Naperville, IL 60563-1262

Mailing address

1560 Wall St Ste 304
Naperville, IL 60563-1262
Phone (630) 416-8289

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
I20200522002398 IL Practitioner - Nurse Practitioner 6608297981 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Conventions Psychiatry and Counseling PCGroup PAC ID 0143113027, 17 clinicians

Practice addresses (Care Compare)

8540 S Harlem Ave
Bridgeview, IL 60455-1778
Phone (708) 598-2605

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209.021220ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Conventions Psychiatry & Counseling, P.C. CurrentSince May 1, 2020 Accepting new patients

Locations

8540 S Harlem Ave
Bridgeview, IL 60455
Phone (708) 594-5440

1560 Wall St
Ste 304
Naperville, IL 60563
Phone (630) 355-1533

4300 Weaver Pkwy
Ste 100
Warrenville, IL 60555

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1588032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588032000000",
    "number": "1811518178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1560 WALL ST STE 304",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605631262",
            "telephone_number": "630-416-8289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1560 WALL ST STE 304",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605631262",
            "telephone_number": "630-416-8289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DELA PENA",
        "first_name": "MICHELLE",
        "credential": "APRN, FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-28",
        "last_updated": "2020-04-28",
        "certification_date": "2020-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.021220",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Naperville, IL

Sources for this page

Verify at the official NPI Registry.