Individual provider Active NPI

Olivia Walsh

  • Nurse Practitioner
  • Chicago, IL
National Provider Identifier
1912457730
Registry record updated Aug 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209014760 Issued in IL
Practice address
675 N Saint Clair St Ste 20-150
Chicago, IL 60611-5979
Phone
(312) 695-8146
Fax
(312) 695-7030
NPI assigned
Oct 4, 2016
Last updated
Aug 28, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2020

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 209014760 IL
Adult Health Nurse Practitioner 363LA2200X 209014760 IL
Gerontology Nurse Practitioner 363LG0600X 209014760 IL
Nurse Practitioner 363L00000X 209014760 IL Primary

Addresses

Primary practice location

675 N Saint Clair St Ste 20-150
Chicago, IL 60611-5979

Mailing address

675 N Saint Clair St Ste 20-150
Chicago, IL 60611-5979
Phone (312) 695-8146

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
I20161026002770 IL Practitioner - Nurse Practitioner 8325326374 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

680 N Lake Shore Dr
Suite 810
Chicago, IL 60611-8700
Phone (312) 926-6146

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.19 of 100Reported as apm
Quality
83.05
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209014760ILMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince Nov 21, 2016 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Nov 21, 2016 Accepting new patients
Central Dupage Physician Group Past Accepting new patients

Locations

Carol Stream, IL 60122
Phone (630) 933-3300

Dept 5777
Carol Stream, IL 60122

251 E Huron St
Chicago, IL 60611

675 N Saint Clair St
Ste 20-150
Chicago, IL 60611
Phone (312) 695-8146

680 N Lake Shore Dr
Ste 1000
Chicago, IL 60611
Phone (312) 695-4022

680 N Lake Shore Dr
Ste 810
Chicago, IL 60611
Phone (312) 926-8811

2701 Patriot Blvd
Glenview, IL 60026
Phone (847) 724-4536

515 Valley View Dr
Ste 201
Moline, IL 61265
Phone (312) 695-0870

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 6

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": "1475539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598572800000",
    "number": "1912457730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 N SAINT CLAIR ST STE 20-150",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606115979",
            "telephone_number": "312-695-8146",
            "fax_number": "312-695-7030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 N SAINT CLAIR ST STE 20-150",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606115979",
            "telephone_number": "312-695-8146",
            "fax_number": "312-695-7030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALSH",
        "first_name": "OLIVIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-04",
        "last_updated": "2020-08-28",
        "certification_date": "2020-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "IL",
            "license": "209014760",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IL",
            "license": "209014760",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IL",
            "license": "209014760",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209014760",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.