Individual provider Active NPI

Marie Ilse, FNP

  • Family Nurse Practitioner
  • Cleveland, OH
National Provider Identifier
1871921676
Registry record updated Aug 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0030457 Issued in OH
Practice address
90500 Euclid Avenue
Cleveland, OH 44195-2055
Phone
(216) 444-2200
NPI assigned
Oct 15, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 16, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP127950 TX
Family Nurse Practitioner 363LF0000X 18537 SC
Family Nurse Practitioner 363LF0000X 9469719 FL
Family Nurse Practitioner 363LF0000X 0030457 OH Primary

Addresses

Primary practice location

90500 Euclid Avenue
Cleveland, OH 44195-2055

Mailing address

22500 Shelburne Rd
Shaker Heights, OH 44122-2055
Phone (267) 549-4985

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, OH2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20171101000798 FL Practitioner - Nurse Practitioner 4587892211 Reassigns benefits to 1 organization
I20220914003819 OH Practitioner - Nurse Practitioner 4587892211 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Cleveland ClinicGroup PAC ID 1850203555, 6,954 clinicians

Practice addresses (Care Compare)

9500 Euclid Ave
Cleveland, OH 44195-0001
Phone (216) 444-5433

Hospital & facility affiliations

  • Cleveland Clinic Hospital, Cleveland, OH, CCN 360180

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9469719FLMDFamily Nurse Practitioner
0030457OHMDFamily Nurse Practitioner
AP127950TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Express Docs, LLC CurrentSince Mar 17, 2022 Accepting new patients
Express Docs, LLC CurrentSince Mar 17, 2022 Accepting new patients
Wooster Clinic, LLC CurrentSince Aug 10, 2022 Accepting new patients
The Cleveland Clinic Foundation CurrentSince Aug 10, 2022 Accepting new patients
Expressdocs2Llc PastSince Feb 11, 2024 Accepting new patients

Locations

14530 S Military Trl
Delray Beach, FL 33484
Phone (561) 381-0260

14530 S Military Trl
Ste A1
Delray Beach, FL 33484
Phone (561) 381-0260

9500 Euclid Ave
Cleveland, OH 44195
Phone (216) 442-1270

6801 Brecksville Rd
Ste 20
Seven Hills, OH 44131
Phone (216) 445-3363

1740 Cleveland Rd
Wooster, OH 44691
Phone (330) 287-4500

Organizations & group practices 5

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.

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": "1381795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660608000000",
    "number": "1871921676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22500 SHELBURNE RD",
            "city": "SHAKER HEIGHTS",
            "state": "OH",
            "postal_code": "441222055",
            "telephone_number": "267-549-4985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90500 EUCLID AVENUE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441952055",
            "telephone_number": "216-444-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ILSE",
        "first_name": "MARIE",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-10-15",
        "last_updated": "2022-08-16",
        "certification_date": "2022-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP127950",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "18537",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "9469719",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "0030457",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

Verify at the official NPI Registry.