Individual provider Active NPI

Elijah Paul Delosreyes

  • Registered Nurse
  • St Charles, IL
National Provider Identifier
1881474518
Registry record updated Oct 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
041530114 Issued in IL
Practice address
41W400 Silver Glen Rd
St Charles, IL 60175-8453
Phone
(630) 940-1100
NPI assigned
Oct 2, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 041530114 IL Primary

Addresses

Primary practice location

41W400 Silver Glen Rd
St Charles, IL 60175-8453

Mailing address

41W400 Silver Glen Rd
St Charles, IL 60175-8453
Phone (630) 940-1100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
041530114ILMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Silver Glen Road Opco LLC CurrentSince Oct 8, 2023 Accepting new patients

Locations

41W400 Silver Glen Rd
St Charles, IL 60175
Phone (331) 901-4225

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": "1696204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696204800000",
    "number": "1881474518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41W400 SILVER GLEN RD",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601758453",
            "telephone_number": "630-940-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41W400 SILVER GLEN RD",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601758453",
            "telephone_number": "630-940-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DELOSREYES",
        "first_name": "ELIJAH PAUL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-10-02",
        "last_updated": "2023-10-02",
        "certification_date": "2023-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041530114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Charles, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 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.