NPIMap

Individual provider Active NPI

Kathleen Ann Ulivi, FNP-BC

  • Family Nurse Practitioner
  • Gardner, IL
National Provider Identifier
1619219110
Registry record updated Mar 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209.010293 Issued in IL
Practice address
409 N US Route 53
Gardner, IL 60424
Phone
(815) 237-0413
Fax
(815) 237-0514
NPI assigned
Mar 22, 2013
Last updated
Mar 30, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209.010293 IL Primary

Addresses

Primary practice location

409 N US Route 53
Gardner, IL 60424

Mailing address

1570 Periwinkle Dr
Morris, IL 60450-6840
Phone (815) 405-7195

Other practice location 1

150 W High St
Morris, IL 60450-1463
Phone (815) 942-2932

Other practice location 2

101 S Prairie Ave
Dwight, IL 60420-1350
Phone (815) 584-3291

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131002000165 IL Practitioner - Nurse Practitioner 5294969440 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Morris HospitalGroup PAC ID 1850372459, 115 clinicians

Practice addresses (Care Compare)

409 N Rte
Suite 53
Gardner, IL 60424
Phone (815) 237-0413

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209.010293ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Morris Hospital CurrentSince Jun 4, 2013 Accepting new patients
Morris Hospital CurrentSince Jun 4, 2013 Accepting new patients
Morris Hospital Current Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
Morris Hospital Past Accepting new patients

Locations

409 N State Route 53
Gardner, IL 60424
Phone (815) 237-0413

580 Sycamore St
Marseilles, IL 61341
Phone (815) 795-2122

150 W High St
Morris, IL 60450
Phone (815) 942-2129

725 School St
Ste A
Morris, IL 60450

Interoperability endpoints

  • Direct secure messaging: kathleen.ulivi.1@14307.direct.athenahealth.com
  • Direct secure messaging: kathleen.ulivi@direct-address.org

Organizations & group practices 5

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 5

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": "1363910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522368000000",
    "number": "1619219110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1570 PERIWINKLE DR",
            "city": "MORRIS",
            "state": "IL",
            "postal_code": "604506840",
            "telephone_number": "815-405-7195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 N US ROUTE 53",
            "city": "GARDNER",
            "state": "IL",
            "postal_code": "60424",
            "telephone_number": "815-237-0413",
            "fax_number": "815-237-0514"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "150 W High St",
            "address_purpose": "LOCATION",
            "city": "Morris",
            "state": "IL",
            "postal_code": "604501463",
            "country_code": "US",
            "telephone_number": "815-942-2932",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "101 S Prairie Ave",
            "address_purpose": "LOCATION",
            "city": "Dwight",
            "state": "IL",
            "postal_code": "604201350",
            "country_code": "US",
            "telephone_number": "815-584-3291",
            "fax_number": "815-584-3475",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ULIVI",
        "first_name": "KATHLEEN",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-22",
        "last_updated": "2018-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.010293",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gardner, IL

Sources for this page

Verify at the official NPI Registry.