Individual provider Active NPI

Carly Louise Vormezeele, PA-C

  • Physician Assistant
  • Rockford, IL
National Provider Identifier
1841756293
Registry record updated Mar 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085.006927 Issued in IL
Practice address
3535 N Bell School Rd
Rockford, IL 61114-6624
Phone
(779) 696-9400
NPI assigned
Feb 11, 2019
Last updated
Mar 3, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 3, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085.006927 IL Primary

Addresses

Primary practice location

3535 N Bell School Rd
Rockford, IL 61114-6624

Mailing address

PO Box 78866
Milwaukee, WI 53278-8866
Phone (779) 696-7150

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cnielsen1029162@direct.uwhealth.org

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
I20190325001390 IL Practitioner - Physician Assistant 0345580668 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Swedishamerican HospitalGroup PAC ID 5799698346, 386 clinicians

Practice addresses (Care Compare)

3505 N Bell School Rd
Rockford, IL 61114-6624
Phone (779) 696-0300

3535 N Bell School Rd
Regional Cancer Center
Rockford, IL 61114-6624
Phone (779) 696-9400

380 E Il Route 38
Sa Rochelle
Rochelle, IL 61068-9694
Phone (779) 696-9050

6824 Newburg Rd
Sa Valley
Rockford, IL 61108-4330
Phone (779) 696-7610

Hospital & facility affiliations

  • Uw Health Hospital, Rockford, IL, CCN 140228

Merit-based Incentive Payment System (MIPS)

Final score
81.51 of 100Reported as group
Quality
83.2
Promoting interoperability
77
Improvement activities
40
Cost
71.7

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085.006927ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Swedishamerican Hospital CurrentSince Mar 1, 2019 Accepting new patients
Swedishamerican Hospital CurrentSince Mar 1, 2019 Accepting new patients
Swedishamerican Hospital Past Accepting new patients

Locations

2550 Charles St
Rockford, IL 61108
Phone (779) 696-7285

3535 N Bell School Rd
Rockford, IL 61114
Phone (779) 696-9400

6824 Newburg Rd
Rockford, IL 61108
Phone (779) 696-7610

Interoperability endpoints

  • Direct secure messaging: lmenningen32885@direct.uwhealth.org

Organizations & group practices 3

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

Hospital & facility affiliations 1

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": "1549843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614729600000",
    "number": "1841756293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 78866",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532788866",
            "telephone_number": "779-696-7150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 N BELL SCHOOL RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611146624",
            "telephone_number": "779-696-9400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VORMEZEELE",
        "first_name": "CARLY",
        "middle_name": "LOUISE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-02-11",
        "last_updated": "2021-03-03",
        "certification_date": "2021-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.006927",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cnielsen1029162@direct.uwhealth.org",
            "affiliation": "N",
            "address_1": "3535 N Bell School Rd",
            "city": "Rockford",
            "state": "IL",
            "country_code": "US",
            "postal_code": "611146624",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

Verify at the official NPI Registry.