Individual provider Active NPI

Aneta Khan

  • Social Worker
  • Crystal Lake, IL
National Provider Identifier
1699485524
Registry record updated Jan 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
150.108425 Issued in IL
Practice address
620 Dakota St
Crystal Lake, IL 60012-3732
Phone
(815) 391-1000
NPI assigned
Dec 1, 2022
Last updated
Jan 14, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X
Social Worker 104100000X 150.108425 IL Primary

Addresses

Primary practice location

620 Dakota St
Crystal Lake, IL 60012-3732

Mailing address

207 Lions CT
Lake Zurich, IL 60047-7013
Phone (847) 903-3615

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241125001853 IL Practitioner - Clinical Social Worker 1759816911 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Rosecrance IncGroup PAC ID 3779656582, 33 clinicians

Practice addresses (Care Compare)

1601 N University Dr
Rockford, IL 61107-5317
Phone (815) 387-2500

620 Dakota St
FL 1
Crystal Lake, IL 60012-3732
Phone (815) 391-1000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
150.108425ILMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Rosecrance Inc Current Accepting new patients
Rosecrance Inc CurrentSince Nov 18, 2024 Accepting new patients
Rosecrance, Inc. CurrentSince Nov 18, 2024 Accepting new patients

Locations

1021 N Mulford Rd
Rockford, IL 61107
Phone (815) 387-5600

1601 University Dr
Rockford, IL 61107
Phone (815) 387-2500

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": "1669852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736812800000",
    "number": "1699485524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 LIONS CT",
            "city": "LAKE ZURICH",
            "state": "IL",
            "postal_code": "600477013",
            "telephone_number": "847-903-3615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 DAKOTA ST",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600123732",
            "telephone_number": "815-391-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "ANETA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-01",
        "last_updated": "2025-01-14",
        "certification_date": "2025-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IL",
            "license": "150.108425",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crystal Lake, IL

Sources for this page

Verify at the official NPI Registry.