| NPI |
1144840703 |
The country code in the location address of the provider being identified. |
| Entity Type Code |
1 |
The telephone number associated with the location address of the provider being identified. |
| Provider Last Name Legal Name |
CAVANAGH |
The date the provider was assigned a unique identifier (assigned an NPI). |
| Provider First Name |
KAITLIN |
The date that a record was last updated or changed. |
| Provider Credential Text |
PA |
The code designating the provider’s gender if the provider is a person. |
| Provider First Line Business Practice Location Address |
880 W CENTRAL RD STE 5000 |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
| Provider Business Practice Location Address City Name |
ARLINGTON HEIGHTS |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
| Provider Business Practice Location Address State Name |
IL |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
| Provider Business Practice Location Address Postal Code |
600052355 |
|
| Provider Business Practice Location Address Country Code If outside U S |
US |
|
| Provider Business Practice Location Address Telephone Number |
8476183800 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
| Provider Business Practice Location Address Fax Number |
8476183809 |
The fax number associated with the location
address of the provider being identified. |
| Provider Enumeration Date |
4/23/2020 |
|
| Last Update Date |
6/30/2021 |
|
| Provider Gender Code |
F |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
| Healthcare Provider Taxonomy Code 1 |
363AS0400X |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
| Provider License Number 1 |
085.008261 |
|
| Provider License Number State Code 1 |
IL |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
| Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
| Other Provider Identifier 1 |
085.008261 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier Type Code 1 |
01 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier State 1 |
IL |
|
| Other Provider Identifier Issuer 1 |
STATE LICENSE |
|
| Is Sole Proprietor |
Y |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
| NPI Certification Date |
6/30/2021 |
|