NPIMap

Organization Active NPI

Novus Illinois Service Corporation

  • Anesthesiology Physician
  • Kankakee, IL
National Provider Identifier
1295491744
Registry record updated Oct 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
NOVUS ILLINOIS SERVICE CORPORATION
Practice address
350 N Wall St
Kankakee, IL 60901-2901
Phone
(159) 357-2568
NPI assigned
Nov 9, 2021
Last updated
Oct 17, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2026

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

Authorized official

Name
Mr. Joshua Poole
Title
President
Phone
(404) 285-8388

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X
Anesthesiology Physician 207L00000X Primary

Addresses

Primary practice location

350 N Wall St
Kankakee, IL 60901-2901

Mailing address

PO Box 12766
Pensacola, FL 32591-2766

Other practice location 1

900 N 2nd St
Rochelle, IL 61068-1764
Phone (815) 562-2181

Other practice location 2

645 S Central Ave
Chicago, IL 60644-5059
Phone (773) 626-4300

Other practice location 3

300 Riverside Dr Ste 1100
Bourbonnais, IL 60914-4997
Phone (815) 802-3170

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cpiapigateway.cms.gov/api/esmdf/ext/v1/fhir/Practitioner/ Other Management Services Network, LLC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220426000454 IL Part B Supplier - Clinic/Group Practice 6901293786 Receives reassigned benefits from 56 practitioners
Practice locations: Rochelle, IL; Kankakee, IL; Chicago, IL; Bourbonnais, IL

National Provider Directory

National Provider Directory

Locations

300 Riverside Dr
Ste 100
Bourbonnais, IL 60914

Practitioners & affiliated clinicians

Practitioners 58

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 58

NPI Registry JSON

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

{
    "created_epoch": "1636416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1792195200000",
    "number": "1295491744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12766",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325912766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 N WALL ST",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609012901",
            "telephone_number": "159-357-2568"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "900 N 2nd St",
            "address_purpose": "LOCATION",
            "city": "Rochelle",
            "state": "IL",
            "postal_code": "610681764",
            "country_code": "US",
            "telephone_number": "815-562-2181",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "645 S Central Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606445059",
            "country_code": "US",
            "telephone_number": "773-626-4300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "300 Riverside Dr Ste 1100",
            "address_purpose": "LOCATION",
            "city": "Bourbonnais",
            "state": "IL",
            "postal_code": "609144997",
            "country_code": "US",
            "telephone_number": "815-802-3170",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NOVUS ILLINOIS SERVICE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-09",
        "last_updated": "2026-10-17",
        "certification_date": "2026-10-17",
        "status": "A",
        "authorized_official_last_name": "POOLE",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "404-285-8388",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cpiapigateway.cms.gov/api/esmdf/ext/v1/fhir/Practitioner/",
            "affiliation": "Y",
            "endpointDescription": "urn:oid:2.16.840.1.113883.3.1036.1",
            "affiliationName": "Management Services Network, LLC",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2357 Warm Springs RD Ste 400",
            "city": "Columbus",
            "state": "GA",
            "country_code": "US",
            "postal_code": "319046874",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kankakee, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.