MARIAM DIALLO FOFANA FNP-BC
NPI 1962867267
Nurse Practitioner - Family in Chicago, IL
About Mariam Diallo Fofana Fnp-bc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MARIAM DIALLO FOFANA FNP-BC (NPI 1962867267) is an individual family provider in Chicago, Illinois, licensed in Illinois (277000533) and active in the NPI registry since December 2015. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Mariam Diallo Fofana Fnp-bc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Mariam Diallo Fofana reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Chicago, IL 60657
- Reassigned Medicare billing, Illinois enrollment
- 4,870 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 60613 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
CHICAGO, IL 60613
CHICAGO, IL 60613
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Mariam Diallo Fofana's NPI number?
The NPI number for Mariam Diallo Fofana is 1962867267. It was assigned to this individual provider in the NPPES registry on December 31, 2015.
Where is Mariam Diallo Fofana located?
Mariam Diallo Fofana practices at 840 W Irving Park Rd, Chicago, IL 60613. The listed phone number is (773) 871-5150.
What is Mariam Diallo Fofana's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Mariam Diallo Fofana enrolled in Medicare?
Yes. Mariam Diallo Fofana is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Mariam Diallo Fofana's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Mariam Diallo Fofana reassigns Medicare benefits to Advocate Health And Hospitals Corp. (Chicago, IL). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Mariam Diallo Fofana's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Mariam Diallo Fofana was last updated on April 29, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Mariam Diallo Fofana, FNP-BC · NPI 1962867267
Family physician in Chicago, Illinois. Individual provider, active in the CMS NPPES registry since December 31, 2015.
## Identity
- **NPI:** 1962867267 (Entity type: Individual)
- **Enumerated:** December 31, 2015
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** 277000533 (Illinois)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 840 W IRVING PARK RD, Chicago, IL 60613-3011
- **Phone:** (773) 871-5150
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Advocate Health And Hospitals Corp. (NPI 1487951711, Chicago, IL), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** April 29, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1962867267) · Data from the CMS NPPES public registry.