Innovative Advanced Practice LLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

INNOVATIVE ADVANCED PRACTICE LLC

Practice address

4050 Healthway Dr Ste 140
Aurora, IL 60504-8184

Phone

(630) 549-5429

Fax

(773) 912-6727

NPI assigned

Aug 24, 2021

Organization subpart

No

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

Authorized official

Name

Ednesha Ramey, NP

Title

Co-Owner/Nurse Practitioner

Phone

(630) 549-5429

Specialties & licenses 3

Addresses

Other identifiers 1

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

{
    "created_epoch": "1629763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684713600000",
    "number": "1881361335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4050 HEALTHWAY DR STE 140",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605048184",
            "telephone_number": "630-549-5429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4050 HEALTHWAY DR STE 140",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605048184",
            "telephone_number": "630-549-5429",
            "fax_number": "773-912-6727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE ADVANCED PRACTICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-24",
        "last_updated": "2023-05-22",
        "certification_date": "2023-05-22",
        "status": "A",
        "authorized_official_last_name": "RAMEY",
        "authorized_official_first_name": "EDNESHA",
        "authorized_official_title_or_position": "CO-OWNER/NURSE PRACTITIONER",
        "authorized_official_telephone_number": "630-549-5429",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1609354133",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.