Staci Lynne Circello, APRN
Individual provider Active NPI Family Nurse Practitioner · Geneseo, IL
NPI 1164065801 · NPPES record last updated Oct 25, 2019
Key facts
- NPI
- 1164065801
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 209.020279 (IL)
- Practice address
- 600 N College Ave
Geneseo, IL 61254-1099 - Phone
- (309) 944-9160
- NPI assigned
- Oct 25, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 8
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Hammond Henry Dist Hospital
Practice addresses (Care Compare)
600 N College Ave
Geneseo, IL 61254-1007
Hospital & facility affiliations
- Hammond Henry Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20191227001753 | IL | Practitioner - Nurse Practitioner | 2860826955 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209.020279 | IL | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hammond Henry Dist Hospital | Current |
Accepting new patients | |
| Hammond Henry Dist Hospital | Current | Accepting new patients |
Locations
1604 Cleveland Rd
Colona, IL 61241
Phone (309) 796-2999
600 N College Ave
Geneseo, IL 61254
Phone (309) 944-6431
600 N College Ave
Ste 120
Geneseo, IL 61254
Phone (309) 944-5342
1258 W South St
Ste 2
Kewanee, IL 61443
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 209.020279 | IL | Yes |
Addresses
Primary practice location
600 N College Ave
Geneseo, IL 61254-1099
Mailing address
600 N College Ave
Geneseo, IL 61254-1099
Phone (309) 944-9160
Other providers in Geneseo, IL
- Kara M Birks
- Sidney Bomkamp
- William A Bordwell
- Melinda Brown
- Bobby J Cain
- Linda T Claeys
- Jill Clong
- Mylee Cole
- Brittany Courson
- Seth Thomas Daniels
All providers in Geneseo, IL · Family Nurse Practitioner in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 25, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.