NPIMap

Individual provider Active NPI

Rose Ann Wan, NP

  • Family Nurse Practitioner
  • Carol Stream, IL
National Provider Identifier
1861913980
Registry record updated Jun 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209.016114 Issued in IL
Practice address
630 E North Ave
Carol Stream, IL 60188-2127
Phone
(630) 861-6663
Fax
(833) 673-0324
NPI assigned
Jun 28, 2017
Last updated
Jun 3, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 3, 2022

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 209.016114 IL Primary

Addresses

Primary practice location

630 E North Ave
Carol Stream, IL 60188-2127

Mailing address

630 E North Ave
Carol Stream, IL 60188-2127
Phone (630) 861-6663

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210525001896 IL Practitioner - Nurse Practitioner 1759653959 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Adventist Health Partners, Inc.Group PAC ID 0244135762, 253 clinicians
At Home Care Physicians PLLCGroup PAC ID 8921570169, 2 clinicians

Practice addresses (Care Compare)

396 Remington Blvd
Bolingbrook, IL 60440-4311

4200 Cantera Dr
Suite 114
Warrenville, IL 60555-3040
Phone (331) 252-4078

630 E N Ave
Carol Stream, IL 60188-2127
Phone (630) 458-5300

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209.016114ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Adventist Health Partners,Inc CurrentSince Jun 1, 2021 Accepting new patients
Adventist Health Partners,Inc CurrentSince Jun 1, 2021 Accepting new patients
Adventist Health Partners, Inc. Current Accepting new patients

Locations

396 Remington Blvd
Ste 231
Bolingbrook, IL 60440
Phone (630) 312-4301

630 E North Ave
Carol Stream, IL 60188
Phone (630) 458-5300

Interoperability endpoints

  • Direct secure messaging: rwan1709357@adventhealth.direct-ci.com

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 10

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": "1498608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654214400000",
    "number": "1861913980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 E NORTH AVE",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "601882127",
            "telephone_number": "630-861-6663",
            "fax_number": "833-673-0324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 E NORTH AVE",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "601882127",
            "telephone_number": "630-861-6663",
            "fax_number": "833-673-0324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAN",
        "first_name": "ROSE ANN",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-06-28",
        "last_updated": "2022-06-03",
        "certification_date": "2022-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.016114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carol Stream, IL

Sources for this page

Verify at the official NPI Registry.