Active NPI
Carol Anne Kotzan, M.D.
- Internal Medicine Physician
- Crystal Lake, IL
National Provider Identifier
1710950100
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 036076689
- Practice address
- 525 E Congress Parkway Suite 250
Crystal Lake, IL 60014-6258 - Phone
- (815) 455-7200
- Fax
- (815) 455-9256
- NPI assigned
- Feb 8, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 036076689 | IL | Primary |
Addresses
Primary practice location
525 E Congress Parkway Suite 250
Crystal Lake, IL 60014-6258
Mailing address
53 Stratham Cir
North Barrington, IL 60010-6908
Phone (815) 455-7200
Other practice location 1
360 Station Drive
Suite 201
Crystal Lake, IL 60014-7978
Phone (815) 455-7200
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036076689 | Medicaid | IL | |
| 5632272 | Other | IL | BCBS |
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: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200226002473 | IL | Order and Referring Only - Internal Medicine | 1850358128 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139356800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1581638400000",
"number": "1710950100",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "53 STRATHAM CIR",
"city": "NORTH BARRINGTON",
"state": "IL",
"postal_code": "600106908",
"telephone_number": "815-455-7200",
"fax_number": "815-455-9256"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "525 E CONGRESS PARKWAY SUITE 250",
"city": "CRYSTAL LAKE",
"state": "IL",
"postal_code": "600146258",
"telephone_number": "815-455-7200",
"fax_number": "815-455-9256"
}
],
"practiceLocations": [
{
"address_1": "360 Station Drive",
"address_2": "Suite 201",
"address_purpose": "LOCATION",
"city": "Crystal Lake",
"state": "IL",
"postal_code": "600147978",
"country_code": "US",
"telephone_number": "815-455-7200",
"fax_number": "815-455-9256",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KOTZAN",
"first_name": "CAROL",
"middle_name": "ANNE",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-02-08",
"last_updated": "2020-02-14",
"certification_date": "2020-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IL",
"license": "036076689",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036076689",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "5632272",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Crystal Lake, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.