1. Home
  2. Directory
  3. Illinois
  4. Rockford
  5. Counselor
  6. NPI Profile

BEACON OF ENLIGHTENMENT
NPI 1376200550
Counselor in Rockford, IL

Active since November 22, 2021
6072 BRYNWOOD DR STE 201, ROCKFORD, IL 61114(815) 564-8633(779) 423-0778 Get Directions Write a Review

NPPES record last updated: April 14, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Nov 29, 2021, Nov 22, 2021 (2 updates tracked since 2021).

About Beacon Of Enlightenment NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BEACON OF ENLIGHTENMENT (NPI 1376200550) is a healthcare organization registered as a counselor in Rockford, Illinois and active in the NPI registry since November 2021. The organization lists Crisy Gowan, Owner, as its authorized official.

NPPES Registry Identity

NPI1376200550
Entity TypeOrganization
Primary Taxonomy101Y00000X
Legal Business NameBEACON OF ENLIGHTENMENT
Location Address6072 BRYNWOOD DR STE 201Rockford, IL 61114-5829
Mailing Address451 Coventry Ln Ste 100Crystal Lake, IL 60014-7589 · (815) 564-8633 · Fax (779) 423-0778
Phone(815) 564-8633
Fax(779) 423-0778
Organization SubpartNo
Authorized OfficialCrisy GowanOwner · (815) 564-8633
Enumeration DateNovember 22, 2021
Last NPPES UpdateApril 14, 20252 updates tracked since enumeration
NPPES CertifiedApril 14, 2025
✔ NPI 1376200550 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselorBehavioral Health & Social Service Providers
Taxonomy Code101Y00000X
Definition
A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.
6072 BRYNWOOD DR STE 201, Rockford, IL 61114
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Beacon Of Enlightenment is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by March 31, 2027

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StateIllinoisEnrollment IDO20220316003456Non-DME Part B · Clinic/Group PracticeDue dateMarch 31, 2027
Source: CMS Revalidation Due Date List, October 2026 release.

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Beacon Of Enlightenment, which bills Medicare for the services they deliver. Of these, 1 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (2)

Latavia Agada, MA, LCSW
Clinical Social Worker
NPI 1417338799
2823 GLENWOOD AVE.
Rockford, IL 61101
(815) 968-5342
✔ PECOS5.2 mi
Alexandria Hummel
Clinical Social Worker
NPI 1487134979
451 COVENTRY LN STE 101
Crystal Lake, IL 60014
(224) 650-7167
✔ PECOS35 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Beacon Of Enlightenment's NPI number?

The NPI number for Beacon Of Enlightenment is 1376200550. It was assigned to this organization in the NPPES registry on November 22, 2021.

Where is Beacon Of Enlightenment located?

Beacon Of Enlightenment is located at 6072 Brynwood Dr Ste 201, Rockford, IL 61114. The listed phone number is (815) 564-8633.

What is Beacon Of Enlightenment's specialty?

The primary specialty registered for this NPI is Counselor with taxonomy code 101Y00000X.

Is Beacon Of Enlightenment enrolled in Medicare?

Yes. Beacon Of Enlightenment is registered in the Medicare PECOS enrollment system.

When is Beacon Of Enlightenment's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Illinois, Clinic/Group Practice) is due for revalidation by March 31, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

How many clinicians bill Medicare through Beacon Of Enlightenment?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Clinical Social Worker, reassign their Medicare billing to Beacon Of Enlightenment. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Beacon Of Enlightenment was last updated on April 14, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.