SHINA KEAONIS GORDON (FNP) – Psychiatric/Mental Health Nurse Practitioner, NPI 1295197697
Psychiatric/Mental Health Nurse Practitioner
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Profile Insights
NPPES metrics only — not quality of care.
11,632 NURSE PRACTITIONER in IL
Provider Addresses for SHINA KEAONIS GORDON (FNP)
4101 1st Ave
Lyons, IL 605341028
Phone: (800) 323-8622
Fax: (224) 225-0394
Type: Location
1341 Warren Ave
Downers Grove, IL 605153437
Phone: (630) 719-5454
Type: Location
2850, West 95th Street, Evergreen Park, Worth Township, Cook County, Illinois, 60805, United States
EVERGREEN PARK, IL 608052735
Phone:
Type: Mailing
3743 HIGHLAND AVE # 2001
DOWNERS GROVE, IL 605151594
Phone: (630) 719-5454
Fax: (630) 719-1263
Type: Location
4101 1ST AVE
LYONS, IL 605341028
Phone: (800) 323-8622
Fax: (224) 225-0394
Type: Location
29373 NETWORK PL
CHICAGO, IL 606731293
Phone: (847) 390-5900
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2016-07-14
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20160714000307 | I | Nurse Practitioner | IL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99203 | New patient office or other outpatient visit, 30-44 minutes | 18 | 18 | $0 |
| 87880 | Detection test by immunoassay with direct visual observation for streptococcus, group a (strep) | 11 | 11 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 11 | 11 | $0 |
Insurance plans in this area (ZIP 60534)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nephrology, Internal Medicine | IL | |
| A N E S T H E S I O L O G Y | IL | |
| - | MN | |
| - | IL | |
| - | IL | |
| Rheumatology, Internal Medicine | IL | |
| - | IL | |
| Internal Medicine | IL | |
| P S Y C H I A T R Y | IL | |
| - | IL |
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