Active NPI
Songquan Jiang, NP
- Adult Health Nurse Practitioner
- Evanston, IL
National Provider Identifier
1992291348
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- 209013070
- Practice address
- 860 Forest Ave Unit a
Evanston, IL 60202-2473 - Phone
- (773) 273-5453
- NPI assigned
- Jul 9, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 209013070 | IL | Primary |
Addresses
Primary practice location
860 Forest Ave Unit a
Evanston, IL 60202-2473
Mailing address
860 Forest Ave Unit a
Evanston, IL 60202-2473
Phone (773) 273-5453
Other practice location 1
3880 Salem Lake Dr Ste F
Long Grove, IL 60047-5292
Phone (847) 719-2220 ext. 222
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2014006230 | Other | IL | ANCC |
| 209013070 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Organizations & group practices 1
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": "1531094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687996800000",
"number": "1992291348",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "860 FOREST AVE UNIT A",
"city": "EVANSTON",
"state": "IL",
"postal_code": "602022473",
"telephone_number": "773-273-5453"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "860 FOREST AVE UNIT A",
"city": "EVANSTON",
"state": "IL",
"postal_code": "602022473",
"telephone_number": "773-273-5453"
}
],
"practiceLocations": [
{
"address_1": "3880 Salem Lake Dr Ste F",
"address_purpose": "LOCATION",
"city": "Long Grove",
"state": "IL",
"postal_code": "600475292",
"country_code": "US",
"telephone_number": "847-719-2220 x222",
"fax_number": "847-719-2265",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JIANG",
"first_name": "SONGQUAN",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-07-09",
"last_updated": "2023-06-29",
"certification_date": "2023-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "IL",
"license": "209013070",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANCC",
"identifier": "2014006230",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "209013070",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Evanston, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2023; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.