Individual provider Active NPI

Minnu Johny

  • Family Nurse Practitioner
  • Des Plaines, IL
National Provider Identifier
1902615065
Registry record updated Jan 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209.030451 Issued in IL
Practice address
9249 Aspen Dr
Des Plaines, IL 60016-4201
Phone
(224) 789-6607
NPI assigned
Jan 3, 2025
Last updated
Jan 3, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2025

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 209.030451 IL Primary

Addresses

Primary practice location

9249 Aspen Dr
Des Plaines, IL 60016-4201

Mailing address

9249 Aspen Dr
Des Plaines, IL 60016-4201
Phone (224) 789-6607

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
I20250421000036 IL Practitioner - Nurse Practitioner 4789109000 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
Telehealth
Offers telehealth services
Group practices
Chicagoland Infectious Disease PCGroup PAC ID 5193948362, 38 clinicians

Practice addresses (Care Compare)

17901 Governors Hwy
Suite 206
Homewood, IL 60430-1146
Phone (708) 880-0559

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209.030451ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Chicagoland Infectious Disease PC CurrentSince Mar 10, 2025 Accepting new patients

Locations

17901 Governors Hwy
Ste 206
Homewood, IL 60430
Phone (708) 957-9100

430 E 162nd St
South Holland, IL 60473
Phone (312) 504-5757

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

NPI Registry JSON

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

{
    "created_epoch": "1735862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735862400000",
    "number": "1902615065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9249 ASPEN DR",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600164201",
            "telephone_number": "224-789-6607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9249 ASPEN DR",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600164201",
            "telephone_number": "224-789-6607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNY",
        "first_name": "MINNU",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-01-03",
        "last_updated": "2025-01-03",
        "certification_date": "2025-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.030451",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Plaines, IL

Sources for this page

Verify at the official NPI Registry.