Active NPI
Monica Plymale
- Nursing Home Administrator
- Rockford, IL
National Provider Identifier
1760830673
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nursing Home Administrator
- License
- 044010510
- Practice address
- 4401 N Main St
Rockford, IL 61103-1277 - Phone
- (815) 921-9200
- Fax
- (815) 877-8304
- NPI assigned
- Jun 1, 2016
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Nursing Home Administrator | 376G00000X | 044010510 | IL | Primary |
Addresses
Primary practice location
4401 N Main St
Rockford, IL 61103-1277
Mailing address
4401 N Main St
Rockford, IL 61103-1277
Phone (815) 921-9200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 366006681 | Medicaid | IL |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 044010510 | IL | MD | Nursing Home Administrator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1464739200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464739200000",
"number": "1760830673",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4401 N MAIN ST",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611031277",
"telephone_number": "815-921-9200",
"fax_number": "815-877-8304"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4401 N MAIN ST",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611031277",
"telephone_number": "815-921-9200",
"fax_number": "815-877-8304"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PLYMALE",
"first_name": "MONICA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-06-01",
"last_updated": "2016-06-01",
"status": "A"
},
"taxonomies": [
{
"code": "376G00000X",
"taxonomy_group": "",
"desc": "Nursing Home Administrator",
"state": "IL",
"license": "044010510",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "366006681",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rockford, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.