Individual provider Active NPI

Yolanta Kreklow

  • Psychiatric/Mental Health Nurse Practitioner
  • Crystal Lake, IL
National Provider Identifier
1750804167
Registry record updated Feb 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
209016064 Issued in IL
Practice address
145 S Virginia St
Crystal Lake, IL 60014-7226
Phone
(815) 444-9999
NPI assigned
Jul 18, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 13, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 209016064 IL Primary

Addresses

Primary practice location

145 S Virginia St
Crystal Lake, IL 60014-7226

Mailing address

145 S Virginia St
Crystal Lake, IL 60014-7226
Phone (815) 444-9999

Other identifiers 1

IdentifierTypeStateIssuer
209016064MedicaidIL

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
I20171213001985 IL Practitioner - Nurse Practitioner 2860489291 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Uhs of Hartgrove, IncGroup PAC ID 3173611738, 15 clinicians

Practice addresses (Care Compare)

5730 W Roosevelt Rd
Hartgrove Hospital
Chicago, IL 60644-1580
Phone (773) 413-1700

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209016064ILMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Uhs of Hartgrove, Inc. CurrentSince Feb 1, 2020 Accepting new patients
Uhs of Hartgrove, Inc CurrentSince Feb 1, 2020 Accepting new patients
Abbington Rehab & Nursing Center LTD PastSince Apr 27, 2004 Accepting new patients
Garfield Park Hospital, LLC Past Accepting new patients

Locations

520 N Ridgeway Ave
Chicago, IL 60624
Phone (773) 265-3700

5730 W Roosevelt Rd
Ofc
Chicago, IL 60644

5730 W Roosevelt Rd
Chicago, IL 60644
Phone (773) 413-1700

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1500336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1518480000000",
    "number": "1750804167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 S VIRGINIA ST",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600147226",
            "telephone_number": "815-444-9999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 S VIRGINIA ST",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600147226",
            "telephone_number": "815-444-9999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KREKLOW",
        "first_name": "YOLANTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-07-18",
        "last_updated": "2018-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "209016064",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209016064",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crystal Lake, IL

Sources for this page

Verify at the official NPI Registry.