NPIMap

Organization Active NPI

Presence St. Mary Hospital

Doing business as Heart Failure Clinic

  • Family Nurse Practitioner
  • Kankakee, IL
National Provider Identifier
1952748071
Registry record updated May 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
PRESENCE ST. MARY HOSPITAL
Doing business as
Heart Failure Clinic
Practice address
500 W Court St
Kankakee, IL 60901-3661
Phone
(815) 937-2200
Fax
(815) 937-2258
NPI assigned
May 30, 2013
Last updated
May 30, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 30, 2013

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

Authorized official

Name
Melvonne Jones
Title
MGR, Credentialing
Phone
(630) 914-2417

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X Primary

Addresses

Primary practice location

500 W Court St
Kankakee, IL 60901-3661

Mailing address

1000 Remington Blvd
Suite 100
Bolingbrook, IL 60440-5114
Phone (630) 914-2417

Other names 1

  • HEART FAILURE CLINIC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Mercy Ctr Health16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

Organizations that report the same tax identification number in the National Provider Directory.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1369872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369872000000",
    "number": "1952748071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 REMINGTON BLVD",
            "address_2": "SUITE 100",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604405114",
            "telephone_number": "630-914-2417",
            "fax_number": "630-914-2499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W COURT ST",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609013661",
            "telephone_number": "815-937-2200",
            "fax_number": "815-937-2258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESENCE ST. MARY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-30",
        "last_updated": "2013-05-30",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "MELVONNE",
        "authorized_official_title_or_position": "MGR, CREDENTIALING",
        "authorized_official_telephone_number": "630-914-2417"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HEART FAILURE CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kankakee, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.