Individual provider Active NPI

Deanna Kane, NP

  • Nurse Practitioner
  • Champaign, IL
National Provider Identifier
1881080372
Registry record updated May 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209012673 Issued in IL
Practice address
1802 S Mattis Ave
Champaign, IL 61821-5923
Phone
(217) 383-3260
Fax
(217) 383-4459
NPI assigned
Apr 10, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 209012673 IL Primary

Addresses

Primary practice location

1802 S Mattis Ave
Champaign, IL 61821-5923

Mailing address

611 W. Park St.
BWPC
Urbana, IL 61801-2500
Phone (217) 383-6792

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
I20150609001576 IL Practitioner - Nurse Practitioner 5193046654 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carle Health Care IncorporatedGroup PAC ID 3577515774, 1,592 clinicians

Practice addresses (Care Compare)

2300 S 1St St
Champaign, IL 61820-7661
Phone (217) 383-9400

611 W Park St
Urbana, IL 61801-2500

611 W Park St
Urbana, IL 61801-2501
Phone (888) 712-2753

Hospital & facility affiliations

  • Carle Foundation Hospital Hospital, Urbana, IL, CCN 140091

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209012673ILMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Carle Health Care Incorporated CurrentSince May 19, 2015 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
Carle Health Care Incorporated Past Accepting new patients

Locations

1802 S Mattis Ave
Champaign, IL 61821
Phone (217) 365-2855

2300 S 1st St
Champaign, IL 61820
Phone (217) 383-9400

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

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 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": "1428624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1432166400000",
    "number": "1881080372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W. PARK ST.",
            "address_2": "BWPC",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618012500",
            "telephone_number": "217-383-6792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1802 S MATTIS AVE",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618215923",
            "telephone_number": "217-383-3260",
            "fax_number": "217-383-4459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANE",
        "first_name": "DEANNA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-10",
        "last_updated": "2015-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209012673",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Champaign, IL

Sources for this page

Verify at the official NPI Registry.