Katy Marie Knolhoff
Individual provider Active NPI Nurse Practitioner · Breese, IL
NPI 1386226504 · NPPES record last updated Mar 28, 2024
Key facts
- NPI
- 1386226504
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 209023020 (IL)
- Practice address
- 9401 Holy Cross LN Ste 223
Breese, IL 62230-3510 - Phone
- (618) 526-7271
- NPI assigned
- Apr 27, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 8
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- St Josephs Hospital Breese of the Hospital Sisters of the Third Orde
Practice addresses (Care Compare)
9401 Holy Cross LN
Suite 112
Breese, IL 62230-3510
Phone (618) 526-7271
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210723000022 | IL | Practitioner - Nurse Practitioner | 5092118430 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209023020 | IL | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Josephs Hospital Breese of the Hospital Sisters of the Third Orde | Current |
Accepting new patients | |
| HSHS Medical Group Inc | Current |
Accepting new patients | |
| HSHS Medical Group Inc | Current |
Accepting new patients | |
| HSHS Medical Group Inc | Current | Accepting new patients | |
| St Josephs Hospital Breese of the Hospital Sisters of the Third Orde | Current |
Accepting new patients | |
| HSHS Medical Group Inc | Past | Accepting new patients |
Locations
9401 Holy Cross Ln
Ste 223
Breese, IL 62230
Phone (618) 526-7271
9401 Holy Cross Ln
Breese, IL 62230
Phone (618) 526-5948
9401 Holy Cross Ln
Ste 112
Breese, IL 62230
Phone (618) 206-2082
9401 Holy Cross Ln
#112
Breese, IL 62230
Phone (618) 526-7271
1900 E Lake Shore Dr
Ste 330
Decatur, IL 62521
Phone (217) 423-2889
1512 N Green Mount Rd
O Fallon, IL 62269
Phone (618) 624-0100
9515 Holy Cross Ln
Saint Rose, IL 62230
Phone (618) 526-4511
Interoperability endpoints
- kkosydor165128@ewd.direct.hshs.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 209023020 | IL | Yes |
Addresses
Primary practice location
9401 Holy Cross LN Ste 223
Breese, IL 62230-3510
Mailing address
9401 Holy Cross LN Ste 223
Breese, IL 62230-3510
Phone (618) 526-7271
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | kkosydor165128@ewd.direct.hshs.org | Direct |
Other providers in Breese, IL
- Kelly Jean Kalmer
- Alyssa M Kampwerth
- David Louis Kee
- Renee Keller
- Jennifer Jo Klostermann
- Monica J Koch
- Megan Lynn Koehler
- Leslie Kohnen
- Amanda Nichole Korte
- Breck D Kramper
All providers in Breese, IL · Nurse Practitioner in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 28, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.