Ashley Erin Boumgarden
Individual provider Active NPI Family Nurse Practitioner · Oak Park, IL
NPI 1912751975 · NPPES record last updated Oct 28, 2024
Key facts
- NPI
- 1912751975
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 209030519 (IL)
- Practice address
- 14 Lake St
Oak Park, IL 60302-2606 - Phone
- (708) 383-0113
- NPI assigned
- Apr 16, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 17
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- PCC Community Wellness Center
Practice addresses (Care Compare)
14 Lake St
Oak Park, IL 60302-2606
Phone 7083830113220005
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260326001270 | IL | Practitioner - Nurse Practitioner | 1658856802 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 041462308 | IL | MD | Registered Nurse |
| 209030519 | IL | MD | Family Nurse Practitioner |
Interoperability endpoints
- ashley.boumgarden.1@13158.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 209030519 | IL | Yes |
| Registered Nurse | 163W00000X | 041462308 | IL |
Addresses
Primary practice location
14 Lake St
Oak Park, IL 60302-2606
Mailing address
1022 S Scoville Ave
Oak Park, IL 60304-2128
Phone (630) 913-1195
Other providers in Oak Park, IL
- Karen Bopp
- Kaylee Borer
- Jonna Borgdorff
- Kelly Boris
- Christina Borjas
- Michael James Bowker
- Kerbi Lorrin Bowman
- Jessica Alana Boy
- Monica Felice Boyd-Layne
- Hope K Boyd
All providers in Oak Park, IL · Family Nurse Practitioner in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 28, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.