Individual provider Active NPI

Carol J Lantz, APN

  • Family Nurse Practitioner
  • Springfield, IL
National Provider Identifier
1114435559
Registry record updated Aug 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209017355 Issued in IL
Practice address
3132 Old Jacksonville Rd
Springfield, IL 62704
Phone
(217) 588-2600
Fax
(217) 862-0904
NPI assigned
Jan 19, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209017355 IL Primary

Addresses

Primary practice location

3132 Old Jacksonville Rd
Springfield, IL 62704

Mailing address

PO Box 3428
Springfield, IL 62708-3428
Phone (217) 588-2624

Other identifiers 1

IdentifierTypeStateIssuer
041361033OtherILRN LICNESE

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
I20180504000023 IL Practitioner - Nurse Practitioner 5496019168 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorial Physician ServicesGroup PAC ID 9032005681, 161 clinicians

Practice addresses (Care Compare)

3132 Old Jacksonville Rd
Suite 200
Springfield, IL 62704-7401
Phone (217) 862-0800

Hospital & facility affiliations

  • Memorial Medical Center Hospital, Springfield, IL, CCN 140148

Merit-based Incentive Payment System (MIPS)

Final score
79.44 of 100Reported as group
Quality
71.79
Promoting interoperability
77
Improvement activities
40
Cost
75.71

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209017355ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Physician Services CurrentSince Mar 16, 2018 Accepting new patients
Memorial Physician Services Current Accepting new patients
Memorial Physician Services CurrentSince Mar 16, 2018 Accepting new patients
Family Medical Center of Chatham, LLC Current Accepting new patients

Locations

101 E Plummer Blvd
Chatham, IL 62629
Phone (217) 483-3487

3132 Old Jacksonville Rd
Ste 200
Springfield, IL 62704
Phone (217) 862-0800

Organizations & group practices 5

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 1

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": "1516320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533859200000",
    "number": "1114435559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3428",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627083428",
            "telephone_number": "217-588-2624",
            "fax_number": "217-757-2021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3132 OLD JACKSONVILLE RD",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "62704",
            "telephone_number": "217-588-2600",
            "fax_number": "217-862-0904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANTZ",
        "first_name": "CAROL",
        "middle_name": "J",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-19",
        "last_updated": "2018-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209017355",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RN LICNESE",
            "identifier": "041361033",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.