NPIMap

Individual provider Active NPI

Stacey Tebbe

  • Nurse Practitioner
  • Mattoon, IL
National Provider Identifier
1073158119
Registry record updated Oct 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209020253 Issued in IL
Practice address
101 Coles Centre Dr
Mattoon, IL 61938-9314
Phone
(217) 234-5110
NPI assigned
Nov 13, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 209020253 IL Primary

Addresses

Primary practice location

101 Coles Centre Dr
Mattoon, IL 61938-9314

Mailing address

101 Coles Centre Dr
Mattoon, IL 61938-9314
Phone (217) 234-5110

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200521000013 IL Practitioner - Nurse Practitioner 9537590898 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
HSHS Medical Group IncGroup PAC ID 5092857821, 212 clinicians

Practice addresses (Care Compare)

503 N Maple St
Effingham, IL 62401-2006
Phone (217) 342-2121

904 Medical Park Dr
Effingham, IL 62401-2193
Phone (217) 540-2350

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.81 of 100Reported as apm
Quality
85.98
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
St Elizabeths Hospital of the Hospital Sisters of the Third Order Current Accepting new patients
St Elizabeths Hospital of the Hospital Sisters of the Third Order CurrentSince Jun 21, 2024 Accepting new patients
HSHS Medical Group Inc Current Accepting new patients
St Anthonys Memorial Hospital of the Hospital Sisters of the Third CurrentSince Feb 10, 2023 Accepting new patients
HSHS Medical Group Inc CurrentSince Jul 1, 2020 Accepting new patients
HSHS Medical Group Inc CurrentSince Jul 1, 2020 Accepting new patients
St Elizabeths Hospital of the Hospital Sisters of the Third Order CurrentSince Jun 21, 2024 Accepting new patients
St Anthonys Memorial Hospital of the Hospital Sisters of the Third CurrentSince Feb 10, 2023 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

1900 E Lake Shore Dr
Ste 330
Decatur, IL 62521
Phone (217) 423-2889

503 N Maple St
Effingham, IL 62401
Phone (217) 342-2121

904 Medical Park Dr
Effingham, IL 62401
Phone (217) 347-1685

101 Coles Centre Dr
Mattoon, IL 61938
Phone (217) 234-5110

1 Saint Elizabeth Blvd
O Fallon, IL 62269
Phone 618234212012438

3051 Hollis Dr
Springfield, IL 62704
Phone (217) 523-5406

Organizations & group practices 9

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1573603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603929600000",
    "number": "1073158119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 COLES CENTRE DR",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619389314",
            "telephone_number": "217-234-5110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 COLES CENTRE DR",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619389314",
            "telephone_number": "217-234-5110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEBBE",
        "first_name": "STACEY",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-13",
        "last_updated": "2020-10-29",
        "certification_date": "2020-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209020253",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mattoon, IL

Sources for this page

Verify at the official NPI Registry.