Individual provider Active NPI

Marie Rodriguez, RN

  • Gerontology Nurse Practitioner
  • Chicago, IL
National Provider Identifier
1982990149
Registry record updated Feb 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
209.025497 Issued in IL
Practice address
4318 S State St
Chicago, IL 60609-3701
Phone
(773) 285-9304
NPI assigned
Jun 24, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 71005662 IN
Gerontology Nurse Practitioner 363LG0600X 71005662 IN
Gerontology Nurse Practitioner 363LG0600X 209.025497 IL Primary

Addresses

Primary practice location

4318 S State St
Chicago, IL 60609-3701

Mailing address

PO Box 746721
Atlanta, GA 30374-6721
Phone (733) 521-5157

Other practice location 1

10110 Donald S. Powers Drive
Suite 101D
Munster, IN 46321
Phone (312) 550-5668

Other identifiers 1

IdentifierTypeStateIssuer
71005662OtherINLICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20160222002449 IN Practitioner - Nurse Practitioner 2163727603 Reassigns benefits to 2 organizations
I20250320003109 IL Practitioner - Nurse Practitioner 2163727603 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209.025497ILMDGerontology Nurse Practitioner
71005662INMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Metro Infectious Disease Consultants LLC CurrentSince Jul 28, 2022 Accepting new patients
Metro Infectious Disease Consultants, LLC CurrentSince Jul 28, 2022 Accepting new patients
Advanced Care Medical Specialists, P.C. CurrentSince Jan 5, 2016 Accepting new patients
Oak Street Health Physicians Group, PC CurrentSince Mar 3, 2025 Accepting new patients

Locations

901 McClintock Dr
Ste 202
Burr Ridge, IL 60527
Phone (630) 654-4201

4318 S State St
Chicago, IL 60609
Phone (773) 285-9304

4848 W Irving Park Rd
Chicago, IL 60641
Phone (773) 724-6200

5118 E Lincoln Hwy
Merrillville, IN 46410

3411 N Briarwood Ln
Muncie, IN 47304
Phone (317) 870-1970

10110 Donald S Powers Dr
Ste 101D
Munster, IN 46321
Phone (219) 301-7265

306 Ridge Rd
Munster, IN 46321

10110 Donald S Powers Dr
Munster, IN 46321
Phone (219) 922-8222

931 Ridge Rd
Ste B
Munster, IN 46321
Phone (219) 301-5477

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": "1308873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739836800000",
    "number": "1982990149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746721",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746721",
            "telephone_number": "733-521-5157",
            "fax_number": "312-929-0373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4318 S STATE ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606093701",
            "telephone_number": "773-285-9304"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10110 Donald S. Powers Drive",
            "address_2": "Suite 101D",
            "address_purpose": "LOCATION",
            "city": "Munster",
            "state": "IN",
            "postal_code": "46321",
            "country_code": "US",
            "telephone_number": "312-550-5668",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "MARIE",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-24",
        "last_updated": "2025-02-18",
        "certification_date": "2025-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IN",
            "license": "71005662",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IN",
            "license": "71005662",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IL",
            "license": "209.025497",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "71005662",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.