Cynthia Susan Smith, CNP, ACNP

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

209-001572 Issued in IL

Practice address

1095 Pingree Rd
Suite 108
Crystal Lake, IL 60014-1726

Phone

(815) 459-6655

Fax

(847) 658-9922

NPI assigned

Jul 20, 2006

Last updated

Aug 24, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Ms. Cynthia Susan Graham Other name

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Locations

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

• North Shore Primary Care S.C.

  • Internal Medicine Physician
  • Libertyville, IL
  • NPI 1659563831
  Medicare reassignment NPD
• Rockford Emergency Physicians, LLC

  • Emergency Medicine Physician
  • Rockford, IL
  • NPI 1639876634
  Medicare reassignment NPD

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692835200000",
    "number": "1134149115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1095 PINGREE RD",
            "address_2": "SUITE 108",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600141726",
            "telephone_number": "815-459-6655",
            "fax_number": "847-658-9922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1095 PINGREE RD",
            "address_2": "SUITE 108",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600141726",
            "telephone_number": "815-459-6655",
            "fax_number": "847-658-9922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "CYNTHIA",
        "middle_name": "SUSAN",
        "name_prefix": "Mrs.",
        "credential": "CNP, ACNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-20",
        "last_updated": "2023-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "IL",
            "license": "209-001572",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL SUBSCRIBER",
            "identifier": "309-001579",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADVANCED PRACTICE NURSE",
            "identifier": "209-001572",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL REGISTERED NURSE",
            "identifier": "041-291329",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CYNTHIA",
            "last_name": "GRAHAM",
            "middle_name": "SUSAN",
            "prefix": "MS.",
            "credential": "ACNP-BC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Mari Small
• Lessi J Smebakken, LCSW
• Julie C Smiley, M.A.
• Smith Physical Therapy and Running Academy, LLC (Smith Physical Therapy; Smith Running Academy)
• Corey Daniel Smith
• Denise F Smith, PT
• Jacob Smith
• Jessica Smith
• Melissa K Smith, M. A., CCC-SLP
• Diana Smithana

• Acute Care Nurse Practitioner in Crystal Lake, IL
• Providers in Crystal Lake, IL by specialty
• Acute Care Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.