Judi Kittle Forner

Primary specialty

Adult Health Clinical Nurse SpecialistTaxonomy code 364SA2200X

License

209010514 Issued in IL

Practice address

4309 W Medical Center Dr Ste A200
McHenry, IL 60050

Phone

(815) 759-8070

Fax

(815) 759-4931

NPI assigned

Dec 15, 2014

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 1

Other names 1

• Ms. Judi Lynne Kittle Former name

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

Specialty

Nurse Practitioner

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Saint Anthony Medical Center Hospital, Rockford, IL, CCN 140233
• Osf Saint Paul Medical Center Hospital, Mendota, IL, CCN 141310
• Rochelle Community Hospital Hospital, Rochelle, IL, CCN 141312
• FHN Memorial Hospital Hospital, Freeport, IL, CCN 140160
• Osf Saint Katharine Medical Center Hospital, Dixon, IL, CCN 140012

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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 and National Provider Directory roles.

• Osf Multi-Specialty Group

  • Internal Medicine Physician
  • Peoria, IL
  • NPI 1922445527
  Medicare reassignment Care Compare group NPD
• Central PA Pharmacy LLC.

  • Community/Retail Pharmacy
  • Patton, PA
  • NPI 1578541413
  NPD
• Specialty Physicians of Illinois, LLC

  • Internal Medicine Physician
  • Greenwood, IN
  • NPI 1124075676
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Freeport Memorial Hospital

  • General Acute Care Hospital
  • Freeport, IL
  • NPI 1447228788
  Care Compare affiliation
• Mendota Community Hospital

  • Critical Access Hospital
  • Mendota, IL
  • NPI 1609803113
  Care Compare affiliation
• Osf Healthcare System

  • General Acute Care Hospital
  • Dixon, IL
  • NPI 1508683590
  Care Compare affiliation
• Rochelle Community Hospital Association

  • Critical Access Hospital
  • Rochelle, IL
  • NPI 1821053216
  Care Compare affiliation
• Saint Anthony Medical Center

  • General Acute Care Hospital
  • Rockford, IL
  • NPI 1790739977
  Care Compare affiliation

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

{
    "created_epoch": "1418601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539907200000",
    "number": "1194123679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4309 W MEDICAL CENTER DR STE A200",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600508437",
            "telephone_number": "815-759-8070",
            "fax_number": "815-759-4931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4309 W MEDICAL CENTER DR STE A200",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "60050",
            "telephone_number": "815-759-8070",
            "fax_number": "815-759-4931"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10370 Haligus Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Huntley",
            "state": "IL",
            "postal_code": "601429582",
            "country_code": "US",
            "telephone_number": "815-759-8070",
            "fax_number": "815-759-4931",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "360 Station Dr Fl 3",
            "address_purpose": "LOCATION",
            "city": "Crystal Lake",
            "state": "IL",
            "postal_code": "600147978",
            "country_code": "US",
            "telephone_number": "815-759-8070",
            "fax_number": "815-759-4931",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5666 E State St",
            "address_purpose": "LOCATION",
            "city": "Rockford",
            "state": "IL",
            "postal_code": "611082425",
            "country_code": "US",
            "telephone_number": "815-227-2657",
            "fax_number": "815-395-5381",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FORNER",
        "first_name": "JUDI",
        "middle_name": "KITTLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-15",
        "last_updated": "2018-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SA2200X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Adult Health",
            "state": "IL",
            "license": "209010514",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "209010514",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JUDI",
            "last_name": "KITTLE",
            "middle_name": "LYNNE",
            "prefix": "MS.",
            "credential": "APN, ACNS, RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Rebecca Floyd, M.S., CCC-SLP/L
• Benjamin Jeffery Foerster, PA-C
• Joseph E Fojtik, MD
• Melissa Jean Folk-Jednoroz, PSYD
• Tamara Marie Forman
• Allison Foshee, LCPC
• Gisella Foto
• Fox Ridge Medical Associates, LLC
• Fox Ridge Medical Associates, LLC
• Glenda Cordero Fragante, NP-C

• Adult Health Clinical Nurse Specialist in McHenry, IL
• Providers in McHenry, IL by specialty
• Adult Health Clinical Nurse Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2018; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.