NPIMap

Organization Active NPI

Av360 LLC

  • Health Educator
  • Algonquin, IL
National Provider Identifier
1013515501
Registry record updated Jan 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health EducatorTaxonomy code 174H00000X
Legal business name
AV360 LLC
Practice address
2140 Lake Cook Rd
Algonquin, IL 60102-5447
Phone
(224) 333-0948
Fax
(224) 228-2822
NPI assigned
Oct 15, 2020
Last updated
Jan 11, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Betsy Kostka
Title
Director of Operations
Phone
(224) 520-0390

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Health EducatorGroup: 193400000X SINGLE SPECIALTY GROUP 174H00000X Primary
Case Management Agency 251B00000X
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

2140 Lake Cook Rd
Algonquin, IL 60102-5447

Mailing address

2140 Lake Cook Rd
Algonquin, IL 60102-5447
Phone (224) 333-0948

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210903000764 IL Part B Supplier - Clinic/Group Practice 3072919752 Receives reassigned benefits from 9 practitioners
Practice locations: Algonquin, IL; Long Grove, IL

National Provider Directory

National Provider Directory

Locations

2140 Lake Cook Rd
Algonquin, IL 60102
Phone (224) 249-1972

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1602720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641859200000",
    "number": "1013515501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2140 LAKE COOK RD",
            "city": "ALGONQUIN",
            "state": "IL",
            "postal_code": "601025447",
            "telephone_number": "224-333-0948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2140 LAKE COOK RD",
            "city": "ALGONQUIN",
            "state": "IL",
            "postal_code": "601025447",
            "telephone_number": "224-333-0948",
            "fax_number": "224-228-2822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AV360 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-15",
        "last_updated": "2022-01-11",
        "certification_date": "2022-01-11",
        "status": "A",
        "authorized_official_last_name": "KOSTKA",
        "authorized_official_first_name": "BETSY",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "224-520-0390"
    },
    "taxonomies": [
        {
            "code": "174H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Health Educator",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Algonquin, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.