Individual provider Active NPI

Katelyn Marie Vandermast, APN, FNP-BC, NP-C

  • Nurse Practitioner
  • Sycamore, IL
National Provider Identifier
1548644545
Registry record updated Jul 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209013007 Issued in IL
Practice address
1850 Gateway Dr Ste 201
Sycamore, IL 60178-3192
Phone
(815) 766-7021
Fax
(815) 758-5690
NPI assigned
Jul 20, 2015
Last updated
Jul 28, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 209013007 IL Primary
Acute Care Nurse Practitioner 363LA2100X 209013007 IL
Obstetrics & Gynecology Nurse Practitioner 363LX0001X 209013007 IL
Registered Nurse 163W00000X 041-390433 IL

Addresses

Primary practice location

1850 Gateway Dr Ste 201
Sycamore, IL 60178-3192

Mailing address

1850 Gateway Dr Ste 201
Sycamore, IL 60178-3192
Phone (815) 766-7021

Other practice location 1

300 Randall Rd
Geneva, IL 60134-4200
Phone (630) 208-4000

Other practice location 2

2631 Williamsburg Ave Ste 302
Geneva, IL 60134-1128
Phone (630) 377-8500

Other practice location 3

2172 Blackberry Dr Ste 204
Geneva, IL 60134-1106
Phone (630) 347-3890

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161214002694 IL Practitioner - Nurse Practitioner 8527348267 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Central Dupage Physician GroupGroup PAC ID 5890696231, 1,087 clinicians

Practice addresses (Care Compare)

1850 Gateway Dr
Suite 201
Sycamore, IL 60178-3192
Phone (815) 766-7021

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.63 of 100Reported as apm
Quality
88.47
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
041-390433ILMDRegistered Nurse
209013007ILMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Central Dupage Physician Group CurrentSince May 3, 2023 Accepting new patients
Central Dupage Physician Group CurrentSince May 3, 2023 Accepting new patients

Locations

Carol Stream, IL 60122
Phone (630) 933-3300

Dept 5777
Carol Stream, IL 60122

300 Randall Rd
Geneva, IL 60134
Phone (630) 208-4009

1850 Gateway Dr
Ste 201
Sycamore, IL 60178
Phone (815) 766-7021

1800 N Main St
Wheaton, IL 60187
Phone (630) 469-0045

Organizations & group practices 3

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 3

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": "1437350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690502400000",
    "number": "1548644545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1850 GATEWAY DR STE 201",
            "city": "SYCAMORE",
            "state": "IL",
            "postal_code": "601783192",
            "telephone_number": "815-766-7021",
            "fax_number": "815-758-5690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 GATEWAY DR STE 201",
            "city": "SYCAMORE",
            "state": "IL",
            "postal_code": "601783192",
            "telephone_number": "815-766-7021",
            "fax_number": "815-758-5690"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 Randall Rd",
            "address_purpose": "LOCATION",
            "city": "Geneva",
            "state": "IL",
            "postal_code": "601344200",
            "country_code": "US",
            "telephone_number": "630-208-4000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2631 Williamsburg Ave Ste 302",
            "address_purpose": "LOCATION",
            "city": "Geneva",
            "state": "IL",
            "postal_code": "601341128",
            "country_code": "US",
            "telephone_number": "630-377-8500",
            "fax_number": "630-377-8501",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2172 Blackberry Dr Ste 204",
            "address_purpose": "LOCATION",
            "city": "Geneva",
            "state": "IL",
            "postal_code": "601341106",
            "country_code": "US",
            "telephone_number": "630-347-3890",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANDERMAST",
        "first_name": "KATELYN",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "APN, FNP-BC, NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-20",
        "last_updated": "2023-07-28",
        "certification_date": "2022-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209013007",
            "primary": true
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "IL",
            "license": "209013007",
            "primary": false
        },
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "IL",
            "license": "209013007",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041-390433",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sycamore, IL

Sources for this page

Verify at the official NPI Registry.