Individual provider Active NPI

Abby Antczak, APRN

  • Family Nurse Practitioner
  • Rockford, IL
National Provider Identifier
1194545749
Registry record updated Oct 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209.030791 Issued in IL
Practice address
3775 N Mulford Rd
Rockford, IL 61114-5632
Phone
(779) 696-9202
NPI assigned
Oct 16, 2024
Last updated
Oct 16, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2024

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 209.030791 IL Primary

Addresses

Primary practice location

3775 N Mulford Rd
Rockford, IL 61114-5632

Mailing address

3775 N Mulford Rd
Rockford, IL 61114-5632
Phone (779) 696-9202

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
I20241219002100 IL Practitioner - Nurse Practitioner 1052848793 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Swedishamerican HospitalGroup PAC ID 5799698346, 386 clinicians

Practice addresses (Care Compare)

3775 N Mulford Rd
Sa Immediate Care
Rockford, IL 61114-5632
Phone (779) 696-9202

Hospital & facility affiliations

  • Uw Health Hospital, Rockford, IL, CCN 140228

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
209.030791ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Swedishamerican Hospital CurrentSince Dec 16, 2024 Accepting new patients
Swedishamerican Hospital CurrentSince Dec 16, 2024 Accepting new patients
Swedishamerican Hospital Current Accepting new patients

Locations

2550 Charles St
Rockford, IL 61108
Phone (779) 696-7285

3775 N Mulford Rd
Rockford, IL 61114
Phone (779) 696-8400

6824 Newburg Rd
Rockford, IL 61108
Phone (779) 696-7610

Organizations & group practices 3

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.

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": "1729036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729036800000",
    "number": "1194545749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3775 N MULFORD RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611145632",
            "telephone_number": "779-696-9202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3775 N MULFORD RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611145632",
            "telephone_number": "779-696-9202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTCZAK",
        "first_name": "ABBY",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-16",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.030791",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

Verify at the official NPI Registry.