MR. THEODORE CRAIG BROCK (NPI# 1386070480) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386070480 |
| Entity Type | Individual |
| Full Name | MR. THEODORE CRAIG BROCK |
| Credential | APN-BC |
| Practice Address |
304 Randall Rd Geneva IL 60134 |
| Practice Telephone | 6302320610 |
| Practice Fax Number | 6302320675 |
| Mailing Telephone | 6302320610 |
| Mailing Fax Number | 6302320675 |
| Enumeration Date | 2013-09-20 |
| Last Update Date | 2014-10-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | 209010570 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | MEDICAID | 041303225 | 01 |
| IL | MEDICARE RAILROAD (INDIVIDUAL) | P01349683 | 01 |
| IL | MEDICARE PTAN (GROUP) | 206147 | 01 |
| IL | MEDICARE PTAN (INDIVIDUAL) | F400112507 | 01 |
| IL | MEDICARE RAILROAD (GROUP) | CA4748 | 01 |
| Street Address |
304 RANDALL RD |
| City | GENEVA |
| State | IL |
| Zip Code | 60134 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740281815 | Thomas William Zusag | Radiology | 304 Randall Rd, Geneva, IL 60134-4200 | 2005-08-10 |
| 1174131601 | Sarah Jean Kendra | Social Worker | 304 Randall Rd, Geneva, IL 60134-4200 | 2020-07-21 |
| 1114564317 | Sheri Kristine Steele | Nurse Practitioner | 304 Randall Rd, Geneva, IL 60134-4200 | 2019-12-06 |
| 1982182424 | Nicole Marie Daley | Nurse Practitioner | 304 Randall Rd, Geneva, IL 60134-4200 | 2018-08-06 |
| 1508232224 | Laura Hinerman | Nurse Practitioner | 304 Randall Rd, Geneva, IL 60134-4200 | 2015-08-17 |
| 1396120754 | Amanda Doyle | Clinical Nurse Specialist | 304 Randall Rd, Geneva, IL 60134-4200 | 2015-07-28 |
| 1851661862 | Susie Maria White | Emergency Medicine | 304 Randall Rd, Geneva, IL 60134-4200 | 2012-01-06 |
| 1881828275 | Arlene D'souza | Internal Medicine | 304 Randall Rd, Geneva, IL 60134-4200 | 2009-05-13 |
| 1861658288 | Habib Ahmed Shaikh | Internal Medicine | 304 Randall Rd, Geneva, IL 60134-4200 | 2008-08-05 |
| 1023096294 | Neelima D Kabre | Radiology | 304 Randall Rd, Geneva, IL 60134-4200 | 2006-01-06 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902403918 | Glenda Creighton | Physical Therapist | 0n 801 Friendship Way, Geneva, IL 60134 | 2020-10-02 |
| 1467912212 | Cierra Monae French | Family Medicine | Northwestern Medicine Delnor Hospital, 300 Randall Road, Geneva, IL 60134 | 2019-03-20 |
| 1497246227 | Linda Huber | Psychologist | 1541 E Fabyan Pkwy Ste 101, Geneva, IL 60134 | 2018-05-29 |
| 1003305459 | Nicole Collins | Specialist/Technologist | 1125 Lewis Road, Geneva, IL 60134 | 2018-05-01 |
| 1013438704 | Emily Byars | Clinic/Center | 1111 Greenfield Circle, Geneva, IL 60134 | 2017-07-03 |
| 1982142980 | Samantha Courtney | Counselor | 1120 Randall Ct., Geneva, IL 60134 | 2017-02-09 |
| 1073055026 | Physical Rehabilitation Clinics | Physical Therapist | 507 S. 3rd St. Unit I, Geneva, IL 60134 | 2016-11-08 |
| 1265868707 | Gina Marie Gilchrist | Dietitian, Registered | 39w479 W Haladay Ln, Geneva, IL 60134 | 2013-09-16 |
| 1770823585 | William A. Goodfellow | General Practice | 1010 S. Batavia Ave., Geneva, IL 60134 | 2013-02-15 |
| 1467705392 | Kylie L Mack | Physician Assistant | 351 Delnor Dr #100, Geneva, IL 60134 | 2012-10-16 |
| Find all providers in zip 60134 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669022299 | Katelyn Marie Bittner | Nurse Practitioner | 3578 Austin Rd, Geneva, OH 44041-9787 | 2019-09-16 |
| 1770734543 | Southern Family Practice,llc | Nurse Practitioner | 100 W Lake Professional Park Ste 1, Geneva, AL 36340-1200 | 2008-10-09 |
| 1316156599 | Sheila M Degner | Nurse Practitioner | 351 Delnor Dr Ste 302, Geneva, IL 60134-4233 | 2007-05-22 |
| 1477597557 | Jacqueline E Karlsen | Nurse Practitioner | 64 Elizabeth Blackwell St, Geneva, NY 14456-3403 | 2006-06-16 |
| 1316933435 | Pamela S Switzer | Nurse Practitioner | 293 West North St, Geneva, NY 14456-1530 | 2005-09-23 |
| 1114564317 | Sheri Kristine Steele | Nurse Practitioner | 304 Randall Rd, Geneva, IL 60134-4200 | 2019-12-06 |
| 1518423300 | Calyn Joy Georgacopoulos | Nurse Practitioner | 351 Delnor Dr Ste 302, Geneva, IL 60134-4222 | 2019-02-16 |
| 1598230799 | Daniela Henderson | Nurse Practitioner | 200 North St Ste 101, Geneva, NY 14456-1561 | 2018-10-04 |
| 1326521121 | Giselle M Corsiga | Nurse Practitioner | 351 Delnor Dr Ste 302, Geneva, IL 60134-4222 | 2018-09-08 |
| 1477957389 | Fox Valley Family Physicians | Nurse Practitioner | 2425 Fargo Blvd, Geneva, IL 60134-3591 | 2014-10-21 |
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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.