Shiva Tafazoli, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

277000446 Issued in IL

Practice address

1954 Dempster St
Evanston, IL 60202-1016

Phone

(630) 560-5439

Fax

(630) 701-1007

NPI assigned

May 22, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Post Acute Medical PLLCGroup PAC ID 5193156115, 433 clinicians

Altea Medical Illinois PLLCGroup PAC ID 5799129730, 30 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Marys Hospital Hospital, Decatur, IL, CCN 140166

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Altea Medical Illinois PLLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Chicago Heights, IL
  • NPI 1447039227
  Medicare reassignment Care Compare group NPD
• Post Acute Medical PLLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Lanham, MD
  • NPI 1730713025

  IL

  Medicare reassignment Care Compare group NPD
• Complexcare Medical Group Midwest H PLLC

  • Internal Medicine Physician
  • Novi, MI
  • NPI 1457144933

  IL

  Medicare reassignment NPD
• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  IL, Nurse Practitioner

  Medicare reassignment NPD
• Theoria Medical

  • Internal Medicine Physician
  • Novi, MI
  • NPI 1609362375

  IL, Nurse Practitioner

  Medicare reassignment NPD
• Chess Medicine PLLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Montebello, NY
  • NPI 1699385021
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St Marys Hospital Decatur of the Hospital Sisters of the Third Order

  • General Acute Care Hospital
  • Decatur, IL
  • NPI 1326041229
  Care Compare affiliation

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

{
    "created_epoch": "1400716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731974400000",
    "number": "1922410117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 W NORTH AVE",
            "address_2": "STE 402",
            "city": "MELROSE PARK",
            "state": "IL",
            "postal_code": "601601624",
            "telephone_number": "847-235-6130",
            "fax_number": "847-235-6135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1954 DEMPSTER ST",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602021016",
            "telephone_number": "630-560-5439",
            "fax_number": "630-701-1007"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "675 W North Ave Ste 402",
            "address_purpose": "LOCATION",
            "city": "Melrose Park",
            "state": "IL",
            "postal_code": "601601624",
            "country_code": "US",
            "telephone_number": "708-486-2600",
            "fax_number": "708-486-2610",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAFAZOLI",
        "first_name": "SHIVA",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-22",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209011295",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041343828",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "277000446",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melanie Szymanski
• T & L Psychotherapy Group LTD
• T Marie PC
• Alexandra Tabachnick, PHD
• Ana Claudia Taddei, M.D.
• Colleen Michelle Takagishi, R.D.
• Christopher S Takehana, M.D.
• Mark S Talamonti, MD
• Christopher Wallace Talbot, M.D.
• Jessica Talbot, D.O.

• Family Nurse Practitioner in Evanston, IL
• Providers in Evanston, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.