Individual provider Active NPI

Jessica Husarik

  • Nurse Practitioner
  • Bourbonnais, IL
National Provider Identifier
1861266124
Registry record updated Jun 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209-028950 Issued in IL
Practice address
6712 N Convent St
Bourbonnais, IL 60914-1528
Phone
(815) 928-8050
Fax
(815) 928-8932
NPI assigned
Nov 8, 2023
Last updated
Jun 11, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 209-028950 IL Primary

Addresses

Primary practice location

6712 N Convent St
Bourbonnais, IL 60914-1528

Mailing address

900 Rand Rd Ste 300
Des Plaines, IL 60016-2359
Phone (847) 324-3976

Other names 1

  • Jessica Graziani-Simone Former name

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
I20240124001110 IL Practitioner - Nurse Practitioner 4880047083 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

6712 N Convent St
Bourbonnais, IL 60914-1528
Phone (815) 928-8050

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209-028950ILMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Illinois Bone and Joint Institute LLC CurrentSince Dec 3, 2023 Accepting new patients
Illinois Bone and Joint Institute, LLC CurrentSince Dec 3, 2023 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

2101 Waukegan Rd
Ste 110
Bannockburn, IL 60015
Phone (847) 914-9096

6712 N Convent St
Bourbonnais, IL 60914
Phone (815) 348-9500

5057 Paysphere Cir
Chicago, IL 60674

900 Rand Rd
Ste 300
Des Plaines, IL 60016
Phone (847) 324-3090

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1699401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718064000000",
    "number": "1861266124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 RAND RD STE 300",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600162359",
            "telephone_number": "847-324-3976",
            "fax_number": "847-929-1154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6712 N CONVENT ST",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609141528",
            "telephone_number": "815-928-8050",
            "fax_number": "815-928-8932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUSARIK",
        "first_name": "JESSICA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-08",
        "last_updated": "2024-06-11",
        "certification_date": "2024-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209-028950",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "GRAZIANI-SIMONE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Bourbonnais, IL

Sources for this page

Verify at the official NPI Registry.