Individual provider Active NPI

Kent A Nickell, M.D.

  • Anatomic Pathology Physician
  • Waterloo, IA
National Provider Identifier
1942270004
Registry record updated Apr 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology PhysicianTaxonomy code 207ZP0101X
License
036.148445 Issued in IL
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

Updated by the provider on Apr 20, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
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, IL2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190429002691 WI Practitioner - Pathology 1759271745 Reassigns benefits to 2 organizations
I20190516001597 IL Practitioner - Pathology 1759271745 Reassigns benefits to 5 organizations

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 CorporationGroup PAC ID 7416860440, shared by 14 NPIs, 749 clinicians
Freeport Memorial HospitalGroup PAC ID 8426958232, 168 clinicians
Rockford Health PhysiciansGroup PAC ID 2567374036, 520 clinicians

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 Hospital, Rockford, IL, CCN 140239
  • FHN Memorial Hospital Hospital, Freeport, IL, CCN 140160
  • Mercy Harvard Hospital Hospital, Harvard, IL, CCN 141335
  • Mercyhealth Hospital & Physician Clinic-Crystal la Hospital, Crystal Lake, IL, CCN 140308
  • Mercy Health System Corp Hospital, Janesville, WI, CCN 520066

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036148445ILMDCytopathology Physician
32811IAMDAnatomic Pathology Physician
036.148445ILMDAnatomic Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rockford Health Physicians CurrentSince Apr 13, 2019 Accepting new patients
Mercy Harvard Hospital Inc CurrentSince Dec 1, 2025 Accepting new patients
Mercy Health System Corporation Current Accepting new patients
Mercy Health System Corporation CurrentSince Apr 17, 2019 Accepting new patients
RMH Pathologists, LTD Anatomic Pathology Current Accepting new patients
Mercy Health System Corporation CurrentSince Apr 17, 2019 Accepting new patients
Mercy Harvard Hospital Inc CurrentSince Dec 1, 2025 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.

Hospital & facility affiliations 5

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": "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

Verify at the official NPI Registry.