Active NPI
Santos W Estor, COTA
- Skilled Nursing Facility
- Crystal Lake, IL
National Provider Identifier
1134464928
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 32002250A
- Practice address
- 965 N Brighton Cir
Crystal Lake, IL 60012-2036 - Phone
- (815) 893-7216
- NPI assigned
- Dec 5, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 32002250A | IN | Primary |
Addresses
Primary practice location
965 N Brighton Cir
Crystal Lake, IL 60012-2036
Mailing address
13609 California St Ste 200
Omaha, NE 68154-5245
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 32002250A | IN | MD | Skilled Nursing Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1354665600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1354665600000",
"number": "1134464928",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13609 CALIFORNIA ST STE 200",
"city": "OMAHA",
"state": "NE",
"postal_code": "681545245"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "965 N BRIGHTON CIR",
"city": "CRYSTAL LAKE",
"state": "IL",
"postal_code": "600122036",
"telephone_number": "815-893-7216"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ESTOR",
"first_name": "SANTOS",
"middle_name": "W",
"credential": "COTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-12-05",
"last_updated": "2012-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "IN",
"license": "32002250A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crystal Lake, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.