Individual provider Active NPI

Macy Campbell, APN

  • Pediatric Nurse Practitioner
  • Rockford, IL
National Provider Identifier
1558814673
Registry record updated Jun 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
277-000716 Issued in IL
Practice address
3505 N Bell School Rd
Rockford, IL 61114-6624
Phone
(779) 696-0300
NPI assigned
Jul 25, 2016
Last updated
Jun 28, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 209014491 IL
Pediatric Nurse Practitioner 363LP0200X 277-000716 IL Primary

Addresses

Primary practice location

3505 N Bell School Rd
Rockford, IL 61114-6624

Mailing address

PO Box 78866
Milwaukee, WI 53278-8866
Phone (779) 696-7150

Other names 1

  • Macy Klumpp Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mklumpp1137399@direct.uwhealth.org

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
I20230725002675 IL Practitioner - Nurse Practitioner 2365803293 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209014491ILMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Swedishamerican Hospital CurrentSince Jun 1, 2023 Accepting new patients
Swedishamerican Hospital CurrentSince Jun 1, 2023 Accepting new patients
Swedishamerican Hospital Current Accepting new patients

Locations

1625 S State St
Belvidere, IL 61008
Phone (815) 544-1846

2550 Charles St
Rockford, IL 61108
Phone (779) 696-7285

3505 N Bell School Rd
Rockford, IL 61114
Phone (779) 696-0300

6824 Newburg Rd
Rockford, IL 61108
Phone (779) 696-7610

Interoperability endpoints

  • Direct secure messaging: mklumpp1137399@direct.uwhealth.org

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.

NPI Registry JSON

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

{
    "created_epoch": "1469404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687910400000",
    "number": "1558814673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 78866",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532788866",
            "telephone_number": "779-696-7150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3505 N BELL SCHOOL RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611146624",
            "telephone_number": "779-696-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "MACY",
        "name_prefix": "Mrs.",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-25",
        "last_updated": "2023-06-28",
        "certification_date": "2023-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IL",
            "license": "209014491",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IL",
            "license": "277-000716",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mklumpp1137399@direct.uwhealth.org",
            "affiliation": "N",
            "address_1": "1625 S State St",
            "city": "Belvidere",
            "state": "IL",
            "country_code": "US",
            "postal_code": "610085907",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MACY",
            "last_name": "KLUMPP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Rockford, IL

Sources for this page

Verify at the official NPI Registry.