Active NPI
Nirmala Jain, M.D.
- General Practice Physician
- Park Ridge, IL
National Provider Identifier
1952722167
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 036052696
- Practice address
- 1600 W Touhy Ave
Park Ridge, IL 60068-3050 - Phone
- (847) 696-9396
- NPI assigned
- Dec 16, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 036052696 | IL | Primary |
Addresses
Primary practice location
1600 W Touhy Ave
Park Ridge, IL 60068-3050
Mailing address
860 Winesap CT.
Rivertrail Condominium Unit 9 #305
Prospect HTS, IL 60070
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036052696 | IL | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1387152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456358400000",
"number": "1952722167",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "860 WINESAP CT.",
"address_2": "RIVERTRAIL CONDOMINIUM UNIT 9 #305",
"city": "PROSPECT HTS",
"state": "IL",
"postal_code": "60070"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 W TOUHY AVE",
"city": "PARK RIDGE",
"state": "IL",
"postal_code": "600683050",
"telephone_number": "847-696-9396"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JAIN",
"first_name": "NIRMALA",
"name_prefix": "Mrs.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-12-16",
"last_updated": "2016-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "IL",
"license": "036052696",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Park Ridge, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2016; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.