SA STATELINE CLINIC
NPI 1386054062
Family Medicine in Roscoe, IL
About Sa Stateline Clinic NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SA STATELINE CLINIC (NPI 1386054062) is a healthcare organization registered as a family medicine in Roscoe, Illinois and active in the NPI registry since May 2014. The organization lists Don Daniels, Vp, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 8
Other Names 1
Other Identifiers 1
Group Practice 1
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)
Sa Stateline Clinic is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by February 28, 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.
Clinicians Billing Medicare Through This Organization
474Medicare enrollment records show 474 clinicians reassign Medicare billing to Sa Stateline Clinic, which bills Medicare for the services they deliver. Of these, 9 practice at this address and 27 within 10 miles. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 39
Nearest to this location (20)
See all 474Beloit, WI 53511
Rockford, IL 61103
Rockford, IL 61114
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 Swedishamerican Hospital's NPI number?
The NPI number for Swedishamerican Hospital is 1386054062. It was assigned to this organization in the NPPES registry on May 2, 2014. The provider is also known as Sa Stateline Clinic.
Where is Swedishamerican Hospital located?
Swedishamerican Hospital is located at 4282 E Rockton Rd, Roscoe, IL 61073. The listed phone number is (779) 696-9000.
What is Swedishamerican Hospital's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Swedishamerican Hospital enrolled in Medicare?
Yes. Swedishamerican Hospital is registered in the Medicare PECOS enrollment system.
When is Swedishamerican Hospital'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 February 28, 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 Swedishamerican Hospital?
According to the CMS Revalidation Reassignment List (October 2026 release), 474 clinicians in 39 Medicare specialties reassign their Medicare billing to Swedishamerican Hospital. 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. The largest specialties are Nurse Practitioner (134), Family Practice (63) and Obstetrics/Gynecology (30). Of these, 9 practice at this address and 27 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 Swedishamerican Hospital was last updated on July 12, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years 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.
# Sa Stateline Clinic · NPI 1386054062
Family Medicine organization in Roscoe, Illinois. Organization record, active in the CMS NPPES registry since May 2, 2014.
## Identity
- **NPI:** 1386054062 (Entity type: Organization)
- **Enumerated:** May 2, 2014
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Legal business name:** Swedishamerican Hospital
- **Organization subpart:** No
- **Authorized official:** Don Daniels, VP
## Practice location
- **Address:** 4282 E ROCKTON RD, Roscoe, IL 61073
- **Phone:** (779) 696-9000
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** February 28, 2027 (Non-DME Part B, Illinois, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 474 clinicians in 39 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (134), Family Practice (63), Obstetrics/Gynecology (30); 9 practice at this address and 27 within 10 miles; [full list](https://npiprofile.com/npi/1386054062/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** July 12, 2018
- **Other identifiers:** Other 082 (IL)
---
Source: [NPI Profile](https://npiprofile.com/npi/1386054062) · Data from the CMS NPPES public registry.