Diana Funmilola Wells, APRN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

209018551 Issued in IL

Practice address

31 W 155TH St
Harvey, IL 60426-3556

Phone

(708) 596-5177

NPI assigned

Dec 21, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Diana Perkins Other name

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, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Edgewood Clinical Services P.C.Group PAC ID 3971963901, 304 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lifestancehealth.dianawells@146897.advancedmd-direct.com

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.

• Edgewood Clinical Services, P.C.

  • Psychologist
  • Naperville, IL
  • NPI 1295914646

  Psychiatric/Mental Health

  Medicare reassignment Care Compare group NPD
• Psychology Specialists LTD

  • Clinical Psychologist
  • Bloomington, IL
  • NPI 1053368605
  NPD (past)

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

{
    "created_epoch": "1545350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545350400000",
    "number": "1982176400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 W 155TH ST",
            "city": "HARVEY",
            "state": "IL",
            "postal_code": "604263556",
            "telephone_number": "708-596-5177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 W 155TH ST",
            "city": "HARVEY",
            "state": "IL",
            "postal_code": "604263556",
            "telephone_number": "708-596-5177"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19767 Torrence Ave",
            "address_purpose": "LOCATION",
            "city": "Lynwood",
            "state": "IL",
            "postal_code": "604117624",
            "country_code": "US",
            "telephone_number": "708-596-5177",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WELLS",
        "first_name": "DIANA",
        "middle_name": "FUNMILOLA",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-21",
        "last_updated": "2018-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "209018551",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DIANA",
            "last_name": "PERKINS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Robert C Watkins Jr., MD
• Theresa Watkins, PT
• Theresa Watkins, NURSE PRACTITIONER
• Kent C. Webb, M.D.
• David Weiss, M.D.
• Judith NG Wen, RDN
• West Harvey-Dixmoor SD #147
• Latisha West
• Eugenia V Whalen-Robinson
• Iesha E White

• Psychiatric/Mental Health Nurse Practitioner in Harvey, IL
• Providers in Harvey, IL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2018; 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.