NORTHERN ILLINOIS NEPHROLOGY (NPI# 1205054533) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205054533 |
| Entity Type | Organization |
| Organization Name | NORTHERN ILLINOIS NEPHROLOGY |
| Practice Address |
1340 Charles St Suite 400 Rockford IL 61104-2200 |
| Practice Telephone | 8153989590 |
| Practice Fax Number | 8153989591 |
| Mailing Telephone | 8153989590 |
| Mailing Fax Number | 8153989591 |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. DAVID L WRIGHT (CEO) |
| Authorized Official Telephone | 8153989590 |
| Authorized Official Credential | M.D |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | IL | Other Service Providers |
| Street Address |
1340 CHARLES ST SUITE 400 |
| City | ROCKFORD |
| State | IL |
| Zip Code | 61104-2200 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063418143 | Kathleen Edna Williams | Nurse Practitioner | 1340 Charles St, Ste 201, Rockford, IL 61104 | 2005-06-23 |
| 1124526652 | Drew W Pearson | Registered Nurse | 1340 Charles St, Rockford, IL 61104-2200 | 2018-01-30 |
| 1417483322 | Andrea K Mehlbaum | Registered Nurse | 1340 Charles St, Suite 200, Rockford, IL 61104-2200 | 2017-05-11 |
| 1770030801 | Mary L Marshall | Registered Nurse | 1340 Charles St, Suite 300, Rockford, IL 61104-2200 | 2016-09-07 |
| 1518318047 | Laura G Padron | Registered Nurse | 1340 Charles St, Suite 300, Rockford, IL 61104 | 2016-06-27 |
| 1689056285 | Mary E Novotny | Registered Nurse | 1340 Charles St, Suite 100, Rockford, IL 61104 | 2015-06-19 |
| 1356759294 | Swedishamerican Hospital | Nurse Practitioner | 1340 Charles St, Suite 300, Rockford, IL 61104 | 2014-07-23 |
| 1104237130 | John Russell | Registered Nurse | 1340 Charles St, Suite 300, Rockford, IL 61104 | 2014-05-13 |
| 1760824114 | Kaitlin L Georgiafandis | Physician Assistant | 1340 Charles St, Rockford, IL 61104-2200 | 2013-07-26 |
| 1326486895 | Daniel Clark Painter | Physical Medicine & Rehabilitation | 1340 Charles St, Suite 100, Rockford, IL 61104-2200 | 2013-06-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699216564 | Swedishamerican Hospital | Nutritionist | 1415 E. State St., Lower Level A3, Rockford, IL 61104 | 2017-03-13 |
| 1376950485 | Swedishamerican Hospital | Nurse Practitioner | 1340 Charles St Ste 200, Rockford, IL 61104 | 2014-07-21 |
| 1871907774 | Oday Alsarraf | Psychiatry & Neurology | 1401 E State Street, Center for Mental Health, Swedish American Hospital, Rockford, IL 61104 | 2014-06-18 |
| 1962652339 | Children's Home and Aid | Community/Behavioral Health | 424 7th St, Rockford, IL 61104 | 2008-09-23 |
| 1689729535 | Swedishamerican Hospital | Nurse Practitioner | 1340 Charles St Ste 100, Rockford, IL 61104 | 2007-01-23 |
| 1790873016 | David J Schleicher | Obstetrics & Gynecology | 209 9th St Ste 200, Rockford, IL 61104 | 2006-10-11 |
| 1013026624 | Thomas Ryan Moss | Dentist | 1415 E State Street, Rockford, IL 61104 | 2006-08-29 |
| 1366452096 | Arturo Santiago Manas | Obstetrics & Gynecology | 1415 E State St Fl 8, Rockford, IL 61104 | 2006-08-08 |
| 1245263268 | William John Stout | Physician Assistant | 1401 E State Street, Rockford, IL 61104 | 2006-07-10 |
| 1689604969 | Prabha Chand Dosi | Pediatrics | 1401 E. State Street, Rockford, IL 61104 | 2006-07-03 |
| Find all providers in zip 61104 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053615054 | Lisa Diane Kehoe | Specialist | 1745 Williamsburg Rd, Rockford, IL 61107-2445 | 2011-01-05 |
| 1134445489 | Sanford Bruce Mer | Specialist | 3008 Spring Creek Rd, Rockford, IL 61107-1061 | 2010-04-12 |
| 1225351935 | Rhiannon Marie Deyoung | Specialist | 8450 Algoma Ave Ne Ste Aaa, Rockford, MI 49341-7508 | 2010-03-09 |
| 1689900169 | Jacqueline Michele Sharp | Specialist | 2204 Arthur Ave, Rockford, IL 61101-5224 | 2009-10-19 |
| 1184869893 | Joseph Gerard Lynch | Specialist | 8081 Ravenrock Rd, Rockford, MN 55373-9394 | 2008-12-09 |
| 1548438344 | Helen Wiedemer Laib | Specialist | 4804 Innsbruck Dr, Rockford, IL 61114-7312 | 2008-02-14 |
| 1962609859 | Sandra Rebecca Hallman | Specialist | 6017 Abington Dr, Rockford, IL 61109-2757 | 2007-07-02 |
| 1558481366 | Mark Theodore Peterson | Specialist | 5712 Newburg Rd, Rockford, IL 61108-6707 | 2007-03-29 |
| 1801913769 | Megan D Lindley | Specialist | 610 Vale Ave, Rockford, IL 61107-4656 | 2007-03-24 |
| 1841335072 | Ob-gyn Associates (rockford) Ltd. | Specialist | 1016 Featherstone Road, Rockford Ambulatory Surgery Center, Rockford, IL 61107 | 2007-02-21 |
| Find all providers in ROCKFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.