Individual provider Active NPI

Kimberly A. Cheek, APN, CNP

  • Women's Health Nurse Practitioner
  • Peoria, IL
National Provider Identifier
1063745404
Registry record updated Jan 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Women's Health Nurse PractitionerTaxonomy code 363LW0102X
License
209007744 Issued in IL
Practice address
900 Main St Ste 660
Peoria, IL 61602-1060
Phone
(309) 272-7735
NPI assigned
Sep 17, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 14, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X 209007744 IL Primary

Addresses

Primary practice location

900 Main St Ste 660
Peoria, IL 61602-1060

Mailing address

2901 N Knoxville Ave
Peoria, IL 61603-1747
Phone (309) 688-7010

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110310000860 IL Practitioner - Nurse Practitioner 1456533561 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jody L Kelly MD and Associates, LLCGroup PAC ID 9234119728, 4 clinicians

Practice addresses (Care Compare)

2901 N Knoxville Ave
Peoria, IL 61603-1747
Phone (309) 688-7010

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
209007744ILMDWomen's Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Jody L. Kelly M.D. & Associates, LLC CurrentSince Jan 27, 2020 Accepting new patients

Locations

2901 N Knoxville Ave
Peoria, IL 61603
Phone (309) 688-7010

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1253145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578960000000",
    "number": "1063745404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 N KNOXVILLE AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616031747",
            "telephone_number": "309-688-7010",
            "fax_number": "309-688-7044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 MAIN ST STE 660",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616021060",
            "telephone_number": "309-272-7735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHEEK",
        "first_name": "KIMBERLY",
        "middle_name": "A.",
        "name_prefix": "Mrs.",
        "credential": "APN, CNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-09-17",
        "last_updated": "2020-01-14",
        "certification_date": "2020-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "IL",
            "license": "209007744",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.