1. Home
  2. Directory
  3. Illinois
  4. Elgin
  5. Nurse Anesthetist Certified Registered
  6. NPI Profile

SOUPHAPHONE BOUNMYTHAVONG NICKSIC CRNA
NPI 1740425701
Nurse Anesthetist, Certified Registered in Elgin, IL

Active since December 04, 2008PECOS EnrolledAccepts Medicare Assignment
99.5/100
CMS Quality Rating
1425 N RANDALL RD, ELGIN, IL 60123(224) 783-1065(224) 783-2852 Get Directions Write a Review

NPPES record last updated: August 30, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Aug 30, 2023, Aug 8, 2023, Sep 28, 2022 (3 updates tracked since 2022).

About Souphaphone Bounmythavong Nicksic Crna NPPES

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

SOUPHAPHONE BOUNMYTHAVONG NICKSIC CRNA (NPI 1740425701) is an individual nurse anesthetist, certified registered in Elgin, Illinois, licensed in Illinois (209008677) and active in the NPI registry since December 2008. She is enrolled in Medicare PECOS, is affiliated with Advocate Sherman Hospital, and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1740425701
Entity TypeIndividualFemale
Primary Taxonomy367500000X
Provider Legal NameSOUPHAPHONE BOUNMYTHAVONG NICKSICCredential: CRNA
Location Address1425 N RANDALL RDElgin, IL 60123-2300
Mailing Address29373 Network PlChicago, IL 60673-1293 · (847) 390-5900
Phone(224) 783-1065
Fax(224) 783-2852
Sole ProprietorNo
Medical School CMSOtherGraduated 2009
Enumeration DateDecember 4, 2008
Last NPPES UpdateAugust 30, 20233 updates tracked since enumeration
NPPES CertifiedAugust 30, 2023
✔ NPI 1740425701 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code367500000X
Licenses✔ Licensed in IL · 209008677✔ Licensed in IN · 28181986A
Definition
(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition.
1425 N RANDALL RD, Elgin, IL 60123
Open in Google Maps ↗

Other Names 1

Other Name (5)Sou Bounmythavong Crna

Secondary Practice Locations 2

Location 12600 Greenbush StLafayette, IN 47904-2477 · Phone (765) 448-8000
Location 22475 Dean StSaint Charles, IL 60175-4831 · Phone (630) 584-9800

Other Identifiers 2

Other000000610221IN · Anthem Provider Number
Medicaid200949460IN

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Souphaphone Bounmythavong Nicksic Crna is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2567517691
PECOS Enrollment IDI20120323000591
Eligible to Order & Refer✔ Part B Labs & Imaging– Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

5

Medicare enrollment records show Souphaphone Nicksic reassigns Medicare billing to 5 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Illinois Gastroenterology Group, LLC
1.2 mi
Gastroenterology
745 FLETCHER DRIVE
Elgin, IL 60123
  • Reassigned Medicare billing, Illinois enrollment
  • 235 clinicians in this Medicare group
NPI 1316277817 (847) 888-1300
Valley Ambulatory Surgery Center Anesthesiology Ltd
10 mi
Anesthesiology
2475 DEAN ST
St Charles, IL 60175
  • Reassigned Medicare billing, Illinois enrollment
  • 33 clinicians in this Medicare group
NPI 1629082326 (630) 584-9800
Advocate Health And Hospitals Corporation
24 mi
General Acute Care Hospital
3815 HIGHLAND AVE
Downers Grove, IL 60515
  • Reassigned Medicare billing, Illinois enrollment
  • 4,870 clinicians in this Medicare group
NPI 1578670543 (630) 275-5900
Apollo Medical Group Of Illinois LLC
33 mi
Anesthesiology
3034 W PETERSON AVE
Chicago, IL 60659
  • Reassigned Medicare billing, Illinois enrollment
  • 47 clinicians in this Medicare group
NPI 1730934597 (773) 497-1961
Midwest Anesthesia Providers S.C
249 mi
Anesthesiology
11133 DUNN RD
Saint Louis, MO 63136
  • Reassigned Medicare billing, Illinois enrollment
  • Medicare enrollment name: Midwest Anesthesia Providers Sc
  • 253 clinicians in this Medicare group
NPI 1295189082 (865) 293-5676

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

Areas of Expertise CMS Part B claims 3

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Anesthesia for lens surgery 00142
Anesthesia for lens surgery involves administering medication to numb the eye area, ensuring you feel no pain during the procedure. This can be a local anesthetic (numbing only the eye area) or general (where you're asleep). It helps make the surgery comfortable and stress-free.
25 services25 patients
Anesthesia for other procedure on large bowel using an endoscope 00811
Anesthesia for an endoscopic procedure on the large bowel ensures comfort and relaxation during the procedure. You'll be given medication to make you drowsy or asleep, eliminating any discomfort. The medication can be administered through a vein or inhaled.
19 services19 patients
Anesthesia for procedure on small and large bowel using an endoscope 00813
Anesthesia for an endoscopic procedure on the small and large bowel ensures comfort and relaxation during the procedure. It involves administering medicine to help you sleep or feel drowsy. This allows the doctor to examine your bowels without causing you discomfort or pain.
18 services18 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Advocate Sherman Hospital

Acute Care Hospitals · Elgin, IL
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number140030
Location1425 North Randall RoadElgin, IL 60123 · Kane County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 60123 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$137.43 typical visit price
range $59.81 – $181.38
Typical copayment $34.35 (range $14.95 – $45.34)
Most-billed visit code 99204
Established Patient
$74.38 typical visit price
range $19.15 – $147.12
Typical copayment $18.59 (range $4.78 – $36.78)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

99.5/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality86.15
Promoting Interoperability100
Improvement Activities40

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

TONIA C HANSON PA-C
Physician Assistant
1425 N RANDALL RD, SUITE 404
ELGIN, IL 60123
Kane County (224) 783-8129
NICOLE CARPENTER
Counselor (Mental Health)
1425 N RANDALL RD
ELGIN, IL 60123
Kane County (847) 742-9800
JACLYN MASTRANGELI
Nurse Practitioner (Family)
1425 N RANDALL RD
ELGIN, IL 60123
Kane County (847) 742-9800
DR. WESLEY DANIEL ROBERTS MD
Radiology (Diagnostic Radiology)
1425 N RANDALL RD
ELGIN, IL 60123
Kane County (224) 783-8998
JOHN CORCORAN MD
Emergency Medicine
1425 N RANDALL RD
ELGIN, IL 60123
Kane County (847) 742-9800
SARA RANDAZZO
Nurse Practitioner (Adult Health)
1425 N RANDALL RD
ELGIN, IL 60123
Kane County (224) 742-9800
DR. RICHARD PATRICE ROUSSEAU MD
Anesthesiology
1425 N RANDALL RD
ELGIN, IL 60123
Kane County (847) 742-9800
EMMA COHEN MSW
Social Worker
1425 N RANDALL RD
ELGIN, IL 60123
Kane County (847) 742-9800

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 Souphaphone Nicksic's NPI number?

The NPI number for Souphaphone Nicksic is 1740425701. It was assigned to this individual provider in the NPPES registry on December 4, 2008. The provider is also known as Sou Bounmythavong Crna.

Where is Souphaphone Nicksic located?

Souphaphone Nicksic practices at 1425 N Randall Rd, Elgin, IL 60123. The listed phone number is (224) 783-1065.

What is Souphaphone Nicksic's specialty?

The primary specialty registered for this NPI is Nurse Anesthetist, Certified Registered with taxonomy code 367500000X.

Is Souphaphone Nicksic enrolled in Medicare?

Yes. Souphaphone Nicksic is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Souphaphone Nicksic's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Souphaphone Nicksic reassigns Medicare benefits to 5 organizations: Illinois Gastroenterology Group, LLC (Elgin, IL), Valley Ambulatory Surgery Center Anesthesiology Ltd (St Charles, IL), Advocate Health And Hospitals Corporation (Downers Grove, IL), Apollo Medical Group Of Illinois LLC (Chicago, IL) and Midwest Anesthesia Providers S.C (Saint Louis, MO). Each 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 Souphaphone Nicksic's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

Is Souphaphone Nicksic affiliated with any hospitals?

According to CMS data, Souphaphone Nicksic is affiliated with Advocate Sherman Hospital.

When was this NPI record last updated?

The NPPES record for Souphaphone Nicksic was last updated on August 30, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.