CANDICE VICENCIO FNP NPI 1003442880

Nurse Practitioner in Rockford, IL

Individual Female Nurse Practitioner PECOS Enrolled

About CANDICE VICENCIO

Candice Vicencio is a nurse practitioner (NP) established in Rockford, Illinois and her medical specialization is nurse practitioner. The NPI number of Candice Vicencio is 1003442880 and was assigned on March 2020. The practitioner's primary taxonomy code is 363L00000X with license number 209020086 (IL). The provider is registered as an individual and her NPI record was last updated March 2020.

Candice Vicencio is enrolled in PECOS and is eligible to order or refer healthcare services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

Candice Vicencio is a non-participating provider of Medicare. If you are a Medicare beneficiary this means the provider can charge up to 15% more than Medicare's approved amount for the cost of rendered services, in addition to your normal deductible and coinsurance costs. There are some states that restrict the limiting charge when you see non-participating provider. If you pay the full cost of your care up front, your non- participating provider should still submit a claim to Medicare. Afterward, you should receive reimbursement from Medicare for up 80% of the Medicare-approved amount for the services rendered.

NPI

1003442880

Provider Name CANDICE VICENCIO FNP
Provider Location Address1235 N MULFORD RD STE 222 ROCKFORD, IL 61107
Provider Mailing Address2202 HARLEM RD STE 200 LOVES PARK, IL 61111
GenderFemale
NPI Entity TypeIndividual
Is Sole Proprietor?No
Is Organization Subpart?N/A
Enumeration Date03-12-2020
Last Update Date03-12-2020

Primary Taxonomy

Taxonomy Code363L00000X
ClassificationNurse Practitioner
TypePhysician Assistants & Advanced Practice Nursing Providers
License No.209020086
License StateIL
Taxonomy Description(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

Business Address

CANDICE VICENCIO FNP
1235 N MULFORD RD STE 222
ROCKFORD, IL
ZIP 61107
Phone: (815) 397-8400

Get Directions

Mailing Address

CANDICE VICENCIO FNP
2202 HARLEM RD STE 200
LOVES PARK, IL
ZIP 61111
Phone: (815) 877-4848
Fax: (815) 654-5342

Medicare Participation

Registered in PECOS? Yes What is PECOS?
PECOS is the Medicare Provider, Enrollment, Chain and Ownership System. PECOS is Medicare's enrollment and revalidation system and it is the primary source of information about verified Medicare professionals. A NPI number is necessary to register in PECOS. Providers must enroll in PECOS to avoid denied claims.
Eligible order / refer Part B Clinical Laboratory and ImagingYes
Eligible order / refer Durable Medical EquipmentYes
Eligible order / refer Home Health Agency (HHA)Yes
Eligible order / refer Power Mobility DevicesYes

Other Providers at the same location


The following 3 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1104859107DR. WILLIAM STEPHEN MINORE M.D.
Individual
Anesthesiology (Pain Medicine)1235 N MULFORD RD STE 222
ROCKFORD, IL 61107
(815) 397-8400
1407309982DR. DANIEL ROBERT GREEN DNP, NP-C
Individual
Nurse Practitioner (Family)1235 N MULFORD RD STE 222
ROCKFORD, IL 61107
(815) 397-8400
1891042552DR. AZHAR KOTHAWALA M.D.
Individual
Anesthesiology (Pain Medicine)1235 N MULFORD RD STE 222
ROCKFORD, IL 61107
(815) 397-8400

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.