Souphaphone Bounmythavong Nicksic, CRNA - Medicare Certified Registered Nurse Anesthetist (crna) in Elgin, IL

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Souphaphone Bounmythavong Nicksic, CRNA is a medicare enrolled "Nurse Anesthetist, Certified Registered" in Elgin, Illinois. She graduated from nursing school in 2009 and has 15 years of diverse experience with area of expertise as Certified Registered Nurse Anesthetist (crna). She is a member of the group practice Valley Ambulatory Surgery Center Anesthesiology Ltd, Advocate Health And Hospitals Corporation and her current practice location is 1425 N Randall Rd, Elgin, Illinois. You can reach out to her office (for appointments etc.) via phone at (224) 783-1065.

Souphaphone Bounmythavong Nicksic is licensed to practice in Illinois (license number 209008677) and she also participates in the medicare program. She accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1740425701.

Contact Information

Souphaphone Bounmythavong Nicksic, CRNA
1425 N Randall Rd,
Elgin, IL 60123-2300
(224) 783-1065
(224) 783-2852

Map and Direction




Provider's Profile

Full NameSouphaphone Bounmythavong Nicksic
GenderFemale
SpecialityCertified Registered Nurse Anesthetist (crna)
Experience15 Years
Location1425 N Randall Rd, Elgin, Illinois
Accepts Medicare AssignmentsYes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.
  Medical Education and Training:
  • Souphaphone Bounmythavong Nicksic graduated from nursing school in 2009
  NPI Data:
  • NPI Number: 1740425701
  • Provider Enumeration Date: 12/04/2008
  • Last Update Date: 08/30/2023
  Medicare PECOS Information:
  • PECOS PAC ID: 2567517691
  • Enrollment ID: I20120323000591

Medical Identifiers

Medical identifiers for Souphaphone Bounmythavong Nicksic such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1740425701NPI-NPPES
000000610221OtherINANTHEM PROVIDER NUMBER
200949460MedicaidIN

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
367500000XNurse Anesthetist, Certified Registered 28181986A (Indiana)Secondary
367500000XNurse Anesthetist, Certified Registered 209008677 (Illinois)Primary

Medical Facilities Affiliation

Facility NameLocationFacility Type
Advocate Sherman HospitalElgin, ILHospital

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
Valley Ambulatory Surgery Center Anesthesiology Ltd034522511611
Advocate Health And Hospitals Corporation78108009352484

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Souphaphone Bounmythavong Nicksic allows following entities to bill medicare on her behalf.
Entity NameAdvocate Health And Hospitals Corporation
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1700824455
PECOS PAC ID: 7810800935
Enrollment ID: O20031106000064
Entity NameValley Ambulatory Surgery Center Anesthesiology Ltd
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1629082326
PECOS PAC ID: 0345225116
Enrollment ID: O20040624000312
Entity NameIllinois Gastroenterology Group Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1316277817
PECOS PAC ID: 5193857423
Enrollment ID: O20100721000790
Entity NameMidwest Anesthesia Providers Sc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1295189082
PECOS PAC ID: 9830480581
Enrollment ID: O20160628000182

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Souphaphone Bounmythavong Nicksic is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Souphaphone Bounmythavong Nicksic, CRNA
29373 Network Pl,
Chicago, IL 60673-1293

Ph: (847) 390-5900		Souphaphone Bounmythavong Nicksic, CRNA
1425 N Randall Rd,
Elgin, IL 60123-2300

Ph: (224) 783-1065

Reviews and Comments


Nurse Anesthetist, Certified Registered Nurses in Elgin, IL

Kathryn Orona, CRNA
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Medicare: Accepting Medicare Assignments
Practice Location: 77 N Airlite St, Elgin, IL 60123
Phone: 847-695-3200    
Janine A. Goodsite, CRNA
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Medicare: Accepting Medicare Assignments
Practice Location: 77 N Airlite St, Elgin, IL 60123
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James Redding,
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Medicare: Accepting Medicare Assignments
Practice Location: 1425 N Randall Rd, Elgin, IL 60123
Phone: 224-783-2932    Fax: 224-783-2032
Laura J Sostak, CRNA
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Medicare: Accepting Medicare Assignments
Practice Location: 934 Center St, Elgin, IL 60120
Phone: 847-742-9800    
Joan Young, CRNA
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Medicare: Not Enrolled in Medicare
Practice Location: 77 N Airlite St, Elgin, IL 60123
Phone: 847-695-3200    
Mrs. Ashley Krynski, DNP, CRNA
Nurse Anesthetist - CR
Medicare: Accepting Medicare Assignments
Practice Location: 77 N Airlite St, Elgin, IL 60123
Phone: 847-695-3200    

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.