Individual provider Active NPI

Kristin Tomasino, FNP-BC

  • Family Nurse Practitioner
  • Chicago, IL
National Provider Identifier
1962881722
Registry record updated Dec 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209.012131 Issued in IL
Practice address
3700 W 103Rd St
Chicago, IL 60655-3105
Phone
(773) 298-3712
Fax
(773) 298-3906
NPI assigned
May 27, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209.012131 IL Primary

Addresses

Primary practice location

3700 W 103Rd St
Chicago, IL 60655-3105

Mailing address

603 Ann St
Joliet, IL 60435-5601
Phone (815) 347-3569

Other names 1

  • Kristin Hucek Former name

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
I20161216002215 IL Practitioner - Nurse Practitioner 1153601703 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Saint Xavier UniversityGroup PAC ID 8022245083, 5 clinicians

Practice addresses (Care Compare)

3700 W 103Rd St
Chicago, IL 60655-3105
Phone (773) 298-3712

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209.012131ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Xavier University CurrentSince Nov 8, 2016 Accepting new patients

Locations

3700 W 103rd St
Chicago, IL 60655
Phone (773) 298-3712

3700 W 103rd St
Ste 4
Chicago, IL 60655

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.

NPI Registry JSON

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

{
    "created_epoch": "1432684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480550400000",
    "number": "1962881722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 ANN ST",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604355601",
            "telephone_number": "815-347-3569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 W 103RD ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606553105",
            "telephone_number": "773-298-3712",
            "fax_number": "773-298-3906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOMASINO",
        "first_name": "KRISTIN",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-27",
        "last_updated": "2016-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.012131",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTIN",
            "last_name": "HUCEK",
            "credential": "FNP-BC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.