Individual provider Active NPI

Kristina Rebelsky, LISW

  • Clinical Social Worker
  • Dixon, IL
National Provider Identifier
1205313616
Registry record updated Jan 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
072728 Issued in IA
Practice address
325 Il Route 2
Dixon, IL 61021-9118
Phone
(815) 284-6611
NPI assigned
Jul 27, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 149012642 IL
Clinical Social Worker 1041C0700X 072728 IA Primary

Addresses

Primary practice location

325 Il Route 2
Dixon, IL 61021-9118

Mailing address

325 Il Route 2
Dixon, IL 61021-9118
Phone (815) 284-6611

Other practice location 1

250 20th Ave N Ste 250
Clinton, IA 52732-2506
Phone (563) 243-2124 ext. 108

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250203001736 IL Practitioner - Clinical Social Worker 8628473311 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sinnissippi Centers IncGroup PAC ID 3476459876, 32 clinicians

Practice addresses (Care Compare)

325 Il Route 2
Dixon, IL 61021-9118
Phone 81528466118220

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149012642ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Sinnissippi Centers, Inc. CurrentSince Jan 27, 2025 Accepting new patients
Sinnissippi Centers, Inc. CurrentSince Jan 27, 2025 Accepting new patients

Locations

Rte 2 325 Illinois
Dixon, IL 61021

325 Il Route 2
Dixon, IL 61021
Phone (815) 288-6611

1321 N 7th St
Rochelle, IL 61068
Phone (815) 562-3801

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1532649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737936000000",
    "number": "1205313616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 IL ROUTE 2",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "610219118",
            "telephone_number": "815-284-6611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 IL ROUTE 2",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "610219118",
            "telephone_number": "815-284-6611"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "250 20th Ave N Ste 250",
            "address_purpose": "LOCATION",
            "city": "Clinton",
            "state": "IA",
            "postal_code": "527322506",
            "country_code": "US",
            "telephone_number": "563-243-2124 x108",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REBELSKY",
        "first_name": "KRISTINA",
        "credential": "LISW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-27",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149012642",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IA",
            "license": "072728",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dixon, IL

Sources for this page

Verify at the official NPI Registry.