Individual provider Active NPI

Rebecca Mireles, NP

  • Family Nurse Practitioner
  • New Lenox, IL
National Provider Identifier
1972144715
Registry record updated Nov 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209.019873 Issued in IL
Practice address
1900 Silver Cross Blvd
New Lenox, IL 60451-9509
Phone
(815) 300-1100
NPI assigned
Oct 2, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209.019873 IL Primary

Addresses

Primary practice location

1900 Silver Cross Blvd
New Lenox, IL 60451-9509

Mailing address

1900 Silver Cross Blvd
New Lenox, IL 60451-9509

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
I20191119000225 IL Practitioner - Nurse Practitioner 4284066960 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
209.019873ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Em Strategies,LTD. Emergency Medicine CurrentSince Nov 1, 2019 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Jul 1, 2021 Accepting new patients

Locations

12701 W 143rd St
Lockport, IL 60491
Phone (708) 364-6337

1715 N Division St
Ste 4D5E
Morris, IL 60450

1900 Silver Cross Blvd
New Lenox, IL 60451
Phone (815) 300-7106

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195

Organizations & group practices 4

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": "1569974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572912000000",
    "number": "1972144715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 SILVER CROSS BLVD",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "604519509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 SILVER CROSS BLVD",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "604519509",
            "telephone_number": "815-300-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRELES",
        "first_name": "REBECCA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-02",
        "last_updated": "2019-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.019873",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Lenox, IL

Sources for this page

Verify at the official NPI Registry.