NPIMap

Individual provider Active NPI

Kathryn Gensel, NP

  • Pediatric Nurse Practitioner
  • Peoria, IL
National Provider Identifier
1699740902
Registry record updated Sep 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
209004202 Issued in IL
Practice address
420 NE Glen Oak Ave Ste 401
Dept. of Pediatrics
Peoria, IL 61603-3168
Phone
(309) 624-9844
NPI assigned
Feb 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 209004202 IL Primary

Addresses

Primary practice location

420 NE Glen Oak Ave Ste 401
Dept. of Pediatrics
Peoria, IL 61603-3168

Mailing address

1 Illini Dr
Peoria, IL 61605-2576
Phone (309) 671-8503

Other identifiers 2

IdentifierTypeStateIssuer
IL01DKOtherILJOHN DEERE
07215036OtherILBCBS

Other names 1

  • Kathy Gensel Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209004202ILMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University of Illinois Past Accepting new patients
Board of Trustees of the University of Illinois Past Accepting new patients
University of Illinois Past Accepting new patients
University of Illinois Past Accepting new patients
University of Illinois Past Accepting new patients
University of Illinois Past Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
University of Illinois Past Accepting new patients
University of Illinois Past Accepting new patients

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1140480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378252800000",
    "number": "1699740902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 ILLINI DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616052576",
            "telephone_number": "309-671-8503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 NE GLEN OAK AVE STE 401",
            "address_2": "DEPT. OF PEDIATRICS",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616033168",
            "telephone_number": "309-624-9844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GENSEL",
        "first_name": "KATHRYN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-21",
        "last_updated": "2013-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IL",
            "license": "209004202",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE",
            "identifier": "IL01DK",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "07215036",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHY",
            "last_name": "GENSEL",
            "credential": "NP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Peoria, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.