Individual provider Active NPI

Angela Lytle, FNP

  • Family Nurse Practitioner
  • Alton, IL
National Provider Identifier
1770025868
Registry record updated Apr 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209015110 Issued in IL
Practice address
1 Professional Dr
Alton, IL 62002-5068
Phone
(618) 463-8500
Fax
(618) 463-8537
NPI assigned
Nov 7, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 209015110 IL
Family Nurse Practitioner 363LF0000X 209015110 IL Primary

Addresses

Primary practice location

1 Professional Dr
Alton, IL 62002-5068

Mailing address

6810 State Route 162 Box 215
Maryville, IL 62062-8501
Phone (618) 391-6405

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
I20161130001883 IL Practitioner - Nurse Practitioner 8325328727 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anderson Medical Group LLCGroup PAC ID 5193792018, 136 clinicians

Practice addresses (Care Compare)

6812 State Route 162
Suite 204
Maryville, IL 62062-8562
Phone (618) 391-5070

Hospital & facility affiliations

  • Anderson Hospital Hospital, Maryville, IL, CCN 140289
  • Community Hospital of Staunton Hospital, Staunton, IL, CCN 141306

Merit-based Incentive Payment System (MIPS)

Final score
74.76 of 100Reported as group
Quality
54.98
Promoting interoperability
85
Improvement activities
40
Cost
73.39

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209015110ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Anderson Medical Group, LLC CurrentSince Apr 14, 2018 Accepting new patients

Locations

1103 Belt Line Rd
#B
Collinsville, IL 62234
Phone (618) 344-0090

2090 Vadalabene Dr
Maryville, IL 62062
Phone (618) 288-5430

6810 State Route 162
Ste 215
Maryville, IL 62062
Phone (618) 391-6405

6812 State Route 162
Ste 204
Maryville, IL 62062
Phone (618) 288-6464

Organizations & group practices 1

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1478476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587081600000",
    "number": "1770025868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6810 STATE ROUTE 162 BOX 215",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620628501",
            "telephone_number": "618-391-6405",
            "fax_number": "618-288-4088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 PROFESSIONAL DR",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620025068",
            "telephone_number": "618-463-8500",
            "fax_number": "618-463-8537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYTLE",
        "first_name": "ANGELA",
        "name_prefix": "Ms.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-07",
        "last_updated": "2020-04-17",
        "certification_date": "2020-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209015110",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209015110",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alton, IL

Sources for this page

Verify at the official NPI Registry.