Active NPI
Mary Krall
- Nurse Practitioner
- Pontiac, IL
National Provider Identifier
1275626525
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 041127668/209001388
- Practice address
- 2500 W Reynolds St
Pontiac, IL 61764-9774 - Phone
- (815) 842-3633
- Fax
- (815) 844-6309
- NPI assigned
- Oct 1, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 041127668/209001388 | IL | Primary |
Addresses
Primary practice location
2500 W Reynolds St
Pontiac, IL 61764-9774
Mailing address
2500 W Reynolds St
Pontiac, IL 61764-9774
Phone (815) 842-3633
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)
- Enrolled
- Credentials
- Certified Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 041127668/209001388 | IL | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Joseph Medical Center | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Acute Care Hospital
- Bloomington, IL
- NPI 1619916806
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159660800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1275626525",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2500 W REYNOLDS ST",
"city": "PONTIAC",
"state": "IL",
"postal_code": "617649774",
"telephone_number": "815-842-3633",
"fax_number": "815-844-6309"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 W REYNOLDS ST",
"city": "PONTIAC",
"state": "IL",
"postal_code": "617649774",
"telephone_number": "815-842-3633",
"fax_number": "815-844-6309"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRALL",
"first_name": "MARY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "IL",
"license": "041127668/209001388",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pontiac, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.