Individual provider Active NPI

Alexandra Incandela, DPM

  • Foot & Ankle Surgery Podiatrist
  • Rockford, IL
National Provider Identifier
1336796143
Registry record updated Mar 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
016.006003 Issued in IL
Practice address
5666 E State St
Rockford, IL 61108-2425
Phone
(815) 226-2000
NPI assigned
Aug 26, 2019
Last updated
Mar 28, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 28, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 135.001068 IL
Foot & Ankle Surgery Podiatrist 213ES0103X 016.006003 IL Primary

Addresses

Primary practice location

5666 E State St
Rockford, IL 61108-2425

Mailing address

6962 Cambria CV
Village of Lakewood, IL 60014-6652

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230509000543 IL Practitioner - Podiatry 0941665327 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Saint Anthony Medical CenterGroup PAC ID 5496654006, 45 clinicians
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

5666 E State St
Rockford, IL 61108-2425
Phone (815) 226-2000

5668 E State St
Suite 400
Rockford, IL 61108-2490
Phone (815) 398-7755

8600 State Route 91
Suite 130
Peoria, IL 61615-7829
Phone (309) 683-5050

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
016.006003ILMDFoot & Ankle Surgery Podiatrist
135.001068ILMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Anthony Medical Center CurrentSince May 1, 2023 Accepting new patients
Saint Anthony Medical Center CurrentSince May 1, 2023 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Oct 1, 2024 Accepting new patients
Saint Anthony Medical Center Current Accepting new patients

Locations

1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

5666 E State St
Rockford, IL 61108
Phone (815) 226-2000

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1566777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679961600000",
    "number": "1336796143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6962 CAMBRIA CV",
            "city": "VILLAGE OF LAKEWOOD",
            "state": "IL",
            "postal_code": "600146652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5666 E STATE ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082425",
            "telephone_number": "815-226-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INCANDELA",
        "first_name": "ALEXANDRA",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-08-26",
        "last_updated": "2023-03-28",
        "certification_date": "2023-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IL",
            "license": "135.001068",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IL",
            "license": "016.006003",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

Verify at the official NPI Registry.