Mrs Mary Jane Evangelista, PHD,DNP,PMHNP in Chicago, IL

Mrs Mary Jane Evangelista, PHD,DNP,PMHNP is a medicare enrolled "Nurse Practitioner - Primary Care" in Chicago, Illinois. Her current practice location is 3900 N Pine Grove Ave Apt 414, Chicago, Illinois. You can reach out to her office (for appointments etc.) via phone at (131) 291-2344.

Mrs Mary Jane Evangelista is licensed to practice in Illinois (license number 209.027735) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1720760010.

Contact Information

	Mrs Mary Jane Evangelista, PHD,DNP,PMHNP
	3900 N Pine Grove Ave Apt 414, Chicago, IL 60613-6641
	(131) 291-2344
	Not Available

Map and Direction

Provider's Profile

Full Name	Mrs Mary Jane Evangelista
Gender	Female
Speciality	Nurse Practitioner - Primary Care
Location	3900 N Pine Grove Ave Apt 414, Chicago, Illinois
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1720760010
Provider Enumeration Date: 08/04/2023
Last Update Date: 09/26/2023

Medicare PECOS Information:

PECOS PAC ID: 2163871062
Enrollment ID: I20231216000242

Medical Identifiers

Medical identifiers for Mrs Mary Jane Evangelista such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1720760010	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LP2300X	Nurse Practitioner - Primary Care	209.027735 (Illinois)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mrs Mary Jane Evangelista allows following entities to bill medicare on her behalf.

Entity Name	Bespoke Psychiatry
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1952937104 PECOS PAC ID: 3274951744 Enrollment ID: O20200915002352

Entity Name	Foresight Behavioral Health Clinic Of Humboldt Park, Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1568148344 PECOS PAC ID: 1456704899 Enrollment ID: O20240201000991

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mrs Mary Jane Evangelista is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Mrs Mary Jane Evangelista, PHD,DNP,PMHNP 3900 N Pine Grove Ave Apt 414, Chicago, IL 60613-6641 Ph: (131) 291-2344	Mrs Mary Jane Evangelista, PHD,DNP,PMHNP 3900 N Pine Grove Ave Apt 414, Chicago, IL 60613-6641 Ph: (131) 291-2344

Reviews and Comments

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Mrs Mary Jane Evangelista, PHD,DNP,PMHNP - Medicare Nurse Practitioner in Chicago, IL