Nicholas Guastalli, DO

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036143561 Issued in IL

Practice address

401 N Wall St Ste 102
Kankakee, IL 60901-2934

Phone

(815) 928-5090

Fax

(815) 928-5079

NPI assigned

Feb 10, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal Medicine

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Riverside Health SystemGroup PAC ID 3274434717, 202 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• R.M.C. Home Health Care Home health agency, Peotone, IL, CCN 147400
• Enhabit Home Health Home health agency, Des Plaines, IL, CCN 147292
• Uplifted Care Hospice, Bourbonnais, IL, CCN 141556
• Riverside Medical Center Hospital, Kankakee, IL, CCN 140186
• Presence St Marys Hospital Hospital, Kankakee, IL, CCN 140155

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nguastalli5207@direct.riversidehealthcare.net

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.

• Riverside Health System

  • General Practice Physician
  • Kankakee, IL
  • NPI 1417061193
  Medicare reassignment Care Compare group NPD
• Riverside Health System

  • Psychiatry Physician
  • Kankakee, IL
  • NPI 1336354430
  NPD
• Gibson Community Hospital Association

  • Critical Access Hospital
  • Gibson City, IL
  • NPI 1114935681
  NPD (past)

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

• Eh Home Health of the Midwest, LLC

  • Home Health Agency
  • Des Plaines, IL
  • NPI 1730632423
  Care Compare affiliation
• Hospice of Kankakee Valley, Inc.

  • Community Based Hospice Care Agency
  • Bourbonnais, IL
  • NPI 1811935240
  Care Compare affiliation
• Riverside Medical Center

  • General Acute Care Hospital
  • Kankakee, IL
  • NPI 1538208210
  Care Compare affiliation
• Riverside Medical Center

  • Home Health Agency
  • Peotone, IL
  • NPI 1740346451
  Care Compare affiliation
• St Marys Hospital - Kankakee LLC

  • General Acute Care Hospital
  • Kankakee, IL
  • NPI 1467290809
  Care Compare affiliation

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

{
    "created_epoch": "1391990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1275957334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 N WALL ST STE 102",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609012934",
            "telephone_number": "815-928-5090",
            "fax_number": "815-928-5079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 N WALL ST STE 102",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609012934",
            "telephone_number": "815-928-5090",
            "fax_number": "815-928-5079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUASTALLI",
        "first_name": "NICHOLAS",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-02-10",
        "last_updated": "2022-07-21",
        "certification_date": "2021-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036143561",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nguastalli5207@Direct.riversidehealthcare.net",
            "affiliation": "N",
            "endpointDescription": "Direct address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "401 N Wall St Ste 102",
            "city": "Kankakee",
            "state": "IL",
            "country_code": "US",
            "postal_code": "609012934",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Candice N Gremley, PA-C
• Steven Anthony Groene
• Amanda L Gromnicki
• Stephanie E Grosso, PA-C
• Grow in Illinois
• Sarah Guastalli, PA-C
• Matthew Evan Guimond, NP
• Naga Pushpa Guntupalli, MD
• Anuja Gupta, MD
• Supriya Gupta, MD

• Internal Medicine Physician in Kankakee, IL
• Providers in Kankakee, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.