MARY KOMPERDA APN NPI 1881640902

NPI Information

NPI: 1881640902
Provider Name: MARY KOMPERDA, APN
Classification: Nurse Practitioner - 363LA2200X
Entity Type: Individual

Specialization: Adult Health

PECOS Registration: Yes

Address:
675 W NORTH AVE
STE-210
MELROSE PARK, IL
ZIP 60160
Phone: (708) 450-5094
Get Directions

Mary Komperda, APN is an adult health nurse practitioner in Melrose Park, IL. Mary Komperda, APN NPI is 1881640902. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

675 W NORTH AVE
STE-210
MELROSE PARK, IL
ZIP 60160-634
Phone: (708) 450-5094
Fax: (708) 344-0508

The NPI 1881640902 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 5/26/2006 and was last updated on 8/17/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LA2200X	Nurse Practitioner	Adult Health	209-004003	ILLINOIS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	961280	OTHER	ILLINOIS	MEDICARE GROUP NUMBER
2	1164530713	OTHER	ILLINOIS	CONSULTANTS IN CARDIOVASCULAR MEDICINE, S.C. GROUP NPI NUMBER
3	K18549	OTHER	ILLINOIS	MEDICARE INDIVIDUAL PTAN NUMBER
4	31602469	OTHER	ILLINOIS	BLUE CROSS BLUE SHIELD GROUP PROVIDER NUMBER
5	$$$$$$$$$001	MEDICAID	ILLINOIS
6	CC1592	OTHER	ILLINOIS	RAILROAD MEDICARE GROUP PTAN NUMBER
7	P00236752	OTHER	ILLINOIS	RAILROAD MEDICARE INDIVIDUAL PROVIDER ID
8	209712	OTHER	ILLINOIS	MEDICARE GROUP NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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