Individual provider Active NPI

Marcia A. Zukosky, NP

  • Nurse Practitioner
  • Rockford, IL
National Provider Identifier
1104972249
Registry record updated Nov 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209003606 Issued in IL
Practice address
1221 E State St
Rockford, IL 61104-2231
Phone
(815) 972-1000
Fax
(815) 972-1092
NPI assigned
Jan 25, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 209003606 IL Primary

Addresses

Primary practice location

1221 E State St
Rockford, IL 61104-2231

Mailing address

1221 E State St
Rockford, IL 61104-2231
Phone (815) 972-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040217000957 IL Practitioner - Nurse Practitioner 6901791136 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1983
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1221 E State St
Rockford, IL 61104-2232

1601 Parkview Ave
Rockford, IL 61107-1894

611 W Park St BWPC
Urbana, IL 61801-2500

7707 N Knoxville Ave
Suite 200
Peoria, IL 61614-2014

Hospital & facility affiliations

  • Osf Heart of Mary Medical Center Hospital, Urbana, IL, CCN 140113

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
209003606ILMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Board of Trustees of the University of Illinois CurrentSince Nov 6, 2014 Accepting new patients
Board of Trustees of the University of Illinois CurrentSince Nov 6, 2014 Accepting new patients
The Board of Trustees of the University of Illinois Current Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

1221 E State St
Rockford, IL 61104
Phone (815) 972-1000

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415577600000",
    "number": "1104972249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1221 E STATE ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611042231",
            "telephone_number": "815-972-1000",
            "fax_number": "815-972-1092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 E STATE ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611042231",
            "telephone_number": "815-972-1000",
            "fax_number": "815-972-1092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZUKOSKY",
        "first_name": "MARCIA",
        "middle_name": "A.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-25",
        "last_updated": "2014-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209003606",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

Verify at the official NPI Registry.