Individual provider Active NPI

Hanna Rinkevicz

  • Physician Assistant
  • Rockford, IL
National Provider Identifier
1356104822
Registry record updated May 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085.010350 Issued in IL
Practice address
1200 W State St
Rockford, IL 61102-2112
Phone
(815) 490-1600
Fax
(815) 490-1881
NPI assigned
Feb 6, 2024
Last updated
May 9, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085.010350 IL Primary

Addresses

Primary practice location

1200 W State St
Rockford, IL 61102-2112

Mailing address

1200 W State St
Rockford, IL 61102-2112

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260612003752 MI Practitioner - Physician Assistant 0143763532

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Crusaders Central Clinic AssociationGroup PAC ID 5799682993, shared by 7 NPIs, 31 clinicians

Practice addresses (Care Compare)

1200 W State St
Rockford, IL 61102-2112
Phone (815) 490-1600

Hospital & facility affiliations

  • Uw Health Hospital, Rockford, IL, CCN 140228

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085.010350ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Crusaders Central Clinic Association Past Accepting new patients
Crusaders Central Clinic Association Past Accepting new patients

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, 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": "1707177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715212800000",
    "number": "1356104822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 W STATE ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611022112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 W STATE ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611022112",
            "telephone_number": "815-490-1600",
            "fax_number": "815-490-1881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RINKEVICZ",
        "first_name": "HANNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-06",
        "last_updated": "2024-05-09",
        "certification_date": "2024-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.010350",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

Verify at the official NPI Registry.