Nicole Kellogg, CRNA
Individual provider Active NPI Certified Registered Nurse Anesthetist · Sandwich, IL
NPI 1558070722 · NPPES record last updated Nov 16, 2022
Key facts
- NPI
- 1558070722
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- License
- 209.026203 (IL)
- Practice address
- 1302 N Main St
Sandwich, IL 60548-2587 - Phone
- (630) 936-4029
- NPI assigned
- Nov 16, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Medicare Care Compare profile
- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Ias Illinois PC
Practice addresses (Care Compare)
2525 Kaneville Rd
Geneva, IL 60134-2578
Phone (630) 584-1400
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230421000284 | IL | Practitioner - Certified Registered Nurse Anesthetist (Crna) | 1153786439 | Reassigns benefits to 6 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209.026203 | IL | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stat Anesthesia Specialists, LTD. | Current |
Accepting new patients | |
| Ias Illinois PC | Current |
Accepting new patients | |
| North American Partners in Anesthesia (Illinois), LLC | Current |
Accepting new patients | |
| Oak Brook Anesthesiologists, LTD. | Current |
Accepting new patients |
Locations
1580 W Lake St
Ste 100
Addison, IL 60101
Phone (630) 285-7000
3249 Oak Park Ave
Berwyn, IL 60402
Phone (708) 783-2696
77 N Airlite St
Elgin, IL 60123
Phone (847) 622-3407
2525 Kaneville Rd
Geneva, IL 60134
Phone (630) 584-1400
998 N 129th Infantry Dr
Joliet, IL 60435
Phone (815) 744-3000
18221 Torrence Ave
Ste 1B
Lansing, IL 60438
Phone (708) 474-7600
150 W High St
Morris, IL 60450
Phone (815) 942-2129
2425 W 22nd St
Ste 101
Oak Brook, IL 60523
Phone (630) 312-5000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 209.026203 | IL | Yes |
Addresses
Primary practice location
1302 N Main St
Sandwich, IL 60548-2587
Mailing address
39W044 Patricia LN
Geneva, IL 60134-4813
Phone (847) 525-0660
Other providers in Sandwich, IL
- Kapper Physical Therapy, P.C.
- Kimberly A Kapper
- Karl S. Csiszer, O.D., P.C.
- Diena C Kaser
- Kenneth J Kavanaugh
- Tonya Kennedy
- Ramesh Kola
- Matthew Richard Kuebrich Sr.
- Elizabeth Ann Kuhn
- John F. Lacart
All providers in Sandwich, IL · Certified Registered Nurse Anesthetist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 16, 2022. 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.
- 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.