Individual provider Active NPI

Nicole Noelle Hutson

  • Occupational Therapist
  • Rockford, IL
National Provider Identifier
1285495531
Registry record updated Jan 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
056015857 Issued in IL
Practice address
526 E Jefferson St # 110
Rockford, IL 61107-4076
Phone
(815) 997-5500
Fax
(815) 255-8102
NPI assigned
Jan 23, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 056015857 IL Primary

Addresses

Primary practice location

526 E Jefferson St # 110
Rockford, IL 61107-4076

Mailing address

2122 York Rd Ste 300
Oak Brook, IL 60523-1925
Phone (630) 575-1980

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240319000743 IL Practitioner - Occupational Therapist in Private Practice 8224475827 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Athletico LTDGroup PAC ID 4789602681, 2,187 clinicians

Practice addresses (Care Compare)

526 E Jefferson St
Suite 110
Rockford, IL 61107-4076
Phone (815) 997-5500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
056015857ILMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Athletico LTD Occupational Therapist CurrentSince Jan 21, 2024 Accepting new patients
Athletico LTD CurrentSince Jan 21, 2024 Accepting new patients

Locations

280 N Randall Rd
Lake in the Hills, IL 60156
Phone (847) 854-8219

2122 York Rd
Ste 300
Oak Brook, IL 60523
Phone (630) 575-6250

526 E Jefferson St
Ste 110
Rockford, IL 61107
Phone (815) 255-8102

722 N McLean Blvd
South Elgin, IL 60177
Phone (847) 695-5088

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": "1705968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705968000000",
    "number": "1285495531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2122 YORK RD STE 300",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605231925",
            "telephone_number": "630-575-1980",
            "fax_number": "630-928-5080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "526 E JEFFERSON ST # 110",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611074076",
            "telephone_number": "815-997-5500",
            "fax_number": "815-255-8102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUTSON",
        "first_name": "NICOLE",
        "middle_name": "NOELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-23",
        "last_updated": "2024-01-23",
        "certification_date": "2024-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": "056015857",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.