Active NPI
Kent A Nickell, M.D.
- Anatomic Pathology Physician
- Waterloo, IA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology Physician
- License
- 036.148445
- Practice address
- 1825 Logan Ave
Northeast Iowa Pathology Associates,PC
Waterloo, IA 50703-1916 - Phone
- (319) 235-3679
- Fax
- (319) 233-0722
- NPI assigned
- Jan 23, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology Physician | 207ZP0101X | 32811 | IA | |
| Anatomic Pathology Physician | 207ZP0101X | 036.148445 | IL | Primary |
| Cytopathology Physician | 207ZC0500X | 036148445 | IL |
Addresses
Primary practice location
1825 Logan Ave
Northeast Iowa Pathology Associates,PC
Waterloo, IA 50703-1916
Mailing address
29624 Network PL
Chicago, IL 60673-1296
Phone (815) 971-5000
Other practice location 1
1045 W Stephenson St
Freeport, IL 61032-4864
Phone (815) 599-6000
Other practice location 2
8201 E Riverside Blvd
Rockford, IL 61114-2300
Phone (815) 971-7000
Other practice location 3
875 S Route 31
Crystal Lake, IL 60014-8190
Phone (779) 220-5500
Other practice location 4
1045 W Stephenson St
Freeport, IL 61032-4864
Phone (815) 599-6000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI, IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Pathology
- Education
- Mayo Medical School, 1982
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mercy Health System Corporation
Practice addresses (Care Compare)
1000 Mineral Point Ave
Janesville, WI 53548-2940
Phone (608) 756-6000
1045 W Stephenson St
Freeport, IL 61032-4864
Phone (815) 599-6000
2400 N Rockton Ave
Rockford, IL 61103-3655
Phone (815) 971-5000
875 S Route 31
Crystal Lake, IL 60014-8190
Phone (779) 220-5500
Hospital & facility affiliations
- Javon Bea Hospital
- FHN Memorial Hospital
- Mercy Harvard Hospital
- Mercyhealth Hospital & Physician Clinic-Crystal la
- Mercy Health System Corp
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036148445 | IL | MD | Cytopathology Physician |
| 32811 | IA | MD | Anatomic Pathology Physician |
| 036.148445 | IL | MD | Anatomic Pathology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rockford Health Physicians | Current | Accepting new patients | |
| Mercy Harvard Hospital Inc | Current | Accepting new patients | |
| Mercy Health System Corporation | Current | Accepting new patients | |
| Mercy Health System Corporation | Current | Accepting new patients | |
| RMH Pathologists, LTD | Anatomic Pathology | Current | Accepting new patients |
| Mercy Health System Corporation | Current | Accepting new patients | |
| Mercy Harvard Hospital Inc | Current | Accepting new patients |
Locations
29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652
875 S State Route 31
Crystal Lake, IL 60014
Phone (779) 220-5500
1045 W Stephenson St
Freeport, IL 61032
Phone (815) 599-6105
348 S Division St
Harvard, IL 60033
Phone (815) 943-1122
901 Grant St
Harvard, IL 60033
Phone (815) 943-5431
8201 E Riverside Blvd
Rockford, IL 61114
Phone (815) 971-4066
2400 N Rockton Ave
Rockford, IL 61103
Phone (815) 971-6310
2300 N Rockton Ave
Rockford, IL 61103
Phone (815) 971-5510
1000 Mineral Point Ave
Janesville, WI 53548
Phone (608) 261-6868
N2950 State Road 67
Lake Geneva, WI 53147
Phone (262) 245-0535
Organizations & group practices 9
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.
-
- Multi-Specialty Clinic/Center
- Rockford, IL
- NPI 1043242886
-
- General Acute Care Hospital
- Freeport, IL
- NPI 1447228788
-
- Critical Access Hospital
- Harvard, IL
- NPI 1427001445
-
- Critical Access Hospital
- Lake Geneva, WI
- NPI 1699728550
-
- Family Medicine Physician
- Freeport, IL
- NPI 1457337016
-
- Skilled Nursing Facility
- Harvard, IL
- NPI 1124195557
-
- General Acute Care Hospital
- Janesville, WI
- NPI 1093768962
-
- Anatomic Pathology Physician
- Rockford, IL
- NPI 1184671992
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Freeport, IL
- NPI 1447228788
-
- General Acute Care Hospital
- Rockford, IL
- NPI 1629118609
-
- General Acute Care Hospital
- Crystal Lake, IL
- NPI 1023754371
-
- Critical Access Hospital
- Harvard, IL
- NPI 1427001445
-
- General Acute Care Hospital
- Janesville, WI
- NPI 1093768962
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1776643200000",
"number": "1942270004",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "29624 NETWORK PL",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606731296",
"telephone_number": "815-971-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1825 LOGAN AVE",
"address_2": "NORTHEAST IOWA PATHOLOGY ASSOCIATES,PC",
"city": "WATERLOO",
"state": "IA",
"postal_code": "507031916",
"telephone_number": "319-235-3679",
"fax_number": "319-233-0722"
}
],
"practiceLocations": [
{
"address_1": "1045 W Stephenson St",
"address_purpose": "LOCATION",
"city": "Freeport",
"state": "IL",
"postal_code": "610324864",
"country_code": "US",
"telephone_number": "815-599-6000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "8201 E Riverside Blvd",
"address_purpose": "LOCATION",
"city": "Rockford",
"state": "IL",
"postal_code": "611142300",
"country_code": "US",
"telephone_number": "815-971-7000",
"fax_number": "815-968-4795",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "875 S Route 31",
"address_purpose": "LOCATION",
"city": "Crystal Lake",
"state": "IL",
"postal_code": "600148190",
"country_code": "US",
"telephone_number": "779-220-5500",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1045 W Stephenson St",
"address_purpose": "LOCATION",
"city": "Freeport",
"state": "IL",
"postal_code": "610324864",
"country_code": "US",
"telephone_number": "815-599-6000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NICKELL",
"first_name": "KENT",
"middle_name": "A",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-23",
"last_updated": "2026-04-20",
"certification_date": "2026-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0101X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology",
"state": "IA",
"license": "32811",
"primary": false
},
{
"code": "207ZP0101X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology",
"state": "IL",
"license": "036.148445",
"primary": true
},
{
"code": "207ZC0500X",
"taxonomy_group": "",
"desc": "Pathology, Cytopathology",
"state": "IL",
"license": "036148445",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Waterloo, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.