Organization Active NPI

Northeast Nephrology Consultants

  • Nephrology Physician
  • Joliet, IL
National Provider Identifier
1114035615
Registry record updated Aug 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
042.005614 Issued in IL
Legal business name
NORTHEAST NEPHROLOGY CONSULTANTS
Practice address
3100 Theodore St Ste 201
Joliet, IL 60435-0605
Phone
(815) 717-8750
Fax
(815) 717-8751
NPI assigned
Aug 26, 2006
Last updated
Aug 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2024

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

Authorized official

Name
Kristin L Joyce
Title
Senior Revenue Cycle Supervisor
Phone
(331) 216-1163

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RN0300X
Nephrology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RN0300X 042.005614 IL Primary

Addresses

Primary practice location

3100 Theodore St Ste 201
Joliet, IL 60435-0605

Mailing address

3100 Theodore Street
Suite 201
Joliet, IL 60435
Phone (815) 744-5550

Other practice location 1

1890 Silver Cross Blvd Ste 415
New Lenox, IL 60451-9575
Phone (815) 717-8750

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040121000034 IL Part B Supplier - Clinic/Group Practice 5092617183 Receives reassigned benefits from 5 practitioners
Practice locations: Joliet, IL; New Lenox, IL

National Provider Directory

National Provider Directory

Locations

1200 Maple Rd
#1030
Joliet, IL 60432
Phone (815) 744-5550

3100 Theodore St
Ste 3
Joliet, IL 60435

815 N Larkin Ave
Ste 205
Joliet, IL 60435
Phone (708) 789-5669

368 S Weber Rd
Romeoville, IL 60446
Phone (815) 254-0288

Practitioners & affiliated clinicians

Practitioners 7

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": "1156550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724025600000",
    "number": "1114035615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 THEODORE STREET",
            "address_2": "SUITE 201",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "60435",
            "telephone_number": "815-744-5550",
            "fax_number": "815-744-5428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 THEODORE ST STE 201",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604350605",
            "telephone_number": "815-717-8750",
            "fax_number": "815-717-8751"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1890 Silver Cross Blvd Ste 415",
            "address_purpose": "LOCATION",
            "city": "New Lenox",
            "state": "IL",
            "postal_code": "604519575",
            "country_code": "US",
            "telephone_number": "815-717-8750",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NORTHEAST NEPHROLOGY CONSULTANTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-26",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A",
        "authorized_official_last_name": "JOYCE",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SENIOR REVENUE CYCLE SUPERVISOR",
        "authorized_official_telephone_number": "331-216-1163"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "IL",
            "license": "042.005614",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Joliet, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2024; 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.