Individual provider Active NPI

Ada Wang, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Bolingbrook, IL
National Provider Identifier
1952757973
Registry record updated May 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
209013068 Issued in IL
Practice address
486 W Boughton Rd # B
Bolingbrook, IL 60440-2399
Phone
(630) 755-5278
NPI assigned
May 9, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 209013068 IL Primary

Addresses

Primary practice location

486 W Boughton Rd # B
Bolingbrook, IL 60440-2399

Mailing address

486 W Boughton Rd # B
Bolingbrook, IL 60440-2399
Phone (630) 755-5278

Other identifiers 1

IdentifierTypeStateIssuer
209013068OtherILSTATE LICENSE

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
I20221018000360 IL Practitioner - Nurse Practitioner 4981982279 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Rockford Psychiatric Medical Services SCGroup PAC ID 6901089515, 154 clinicians

Practice addresses (Care Compare)

486 W Boughton Rd
Suite B
Bolingbrook, IL 60440-2399
Phone (630) 566-2090

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209013068ILMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Rockford Psychiatric Medical Services, S.C. CurrentSince Jul 16, 2024 Accepting new patients
Riverside Health System CurrentSince Jan 3, 2023 Accepting new patients
Riverside Health System CurrentSince Jan 3, 2023 Accepting new patients

Locations

486 W Boughton Rd
Ste B
Bolingbrook, IL 60440
Phone (630) 566-2090

300 Riverside Dr
Ste 2100
Bourbonnais, IL 60914
Phone (815) 928-9666

400 S Kennedy Dr
Ste 300
Bradley, IL 60915
Phone (815) 935-8040

1639 N Alpine Rd
Ste 260
Rockford, IL 61107
Phone (815) 395-1500

105 S First St
Wilmington, IL 60481
Phone (815) 476-5210

Interoperability endpoints

  • Direct secure messaging: ada.wang.1@25899.direct.athenahealth.com

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1462752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747267200000",
    "number": "1952757973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "486 W BOUGHTON RD # B",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604402399",
            "telephone_number": "630-755-5278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "486 W BOUGHTON RD # B",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604402399",
            "telephone_number": "630-755-5278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANG",
        "first_name": "ADA",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-09",
        "last_updated": "2025-05-15",
        "certification_date": "2025-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "209013068",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "209013068",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bolingbrook, IL

Sources for this page

Verify at the official NPI Registry.