Individual provider Active NPI

Katherine Merila

  • Nurse Practitioner
  • Morton, IL
National Provider Identifier
1083168447
Registry record updated Oct 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209014554 Issued in IL
Practice address
435 Maxine Drive Suite #4
Morton, IL 61550
Phone
(309) 263-2424
Fax
(309) 284-2244
NPI assigned
Aug 15, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2019

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 209014554 IL Primary

Addresses

Primary practice location

435 Maxine Drive Suite #4
Morton, IL 61550

Mailing address

435 Maxine Drive Suite #4
Morton, IL 61550
Phone (309) 263-2424

Other names 1

  • Katherin Varney Former name

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
I20160914000011 IL Practitioner - Nurse Practitioner 5294021408 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

435 Maxine Dr
Morton, IL 61550-2498
Phone (309) 266-5405

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Osf Multi-Specialty Group CurrentSince Oct 8, 2017 Accepting new patients
Proctor Health Systems Current Accepting new patients
Methodist Medical Center of Illinois CurrentSince Sep 12, 2016 Accepting new patients
Methodist Medical Center of Illinois Nurse Practitioner CurrentSince Sep 12, 2016 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Proctor Health Systems CurrentSince Sep 12, 2016 Accepting new patients
Proctor Health Systems CurrentSince Sep 12, 2016 Accepting new patients
Cardinal Medical Group, LTD. Past Accepting new patients

Locations

1506 W Garfield Ave
Bartonville, IL 61607
Phone (309) 697-2416

2535 E Washington St
East Peoria, IL 61611
Phone (309) 694-6464

435 Maxine Dr
Ste 3
Morton, IL 61550
Phone (309) 263-2424

435 Maxine Dr
Ste 6
Morton, IL 61550

435 Maxine Dr
Ste 4
Morton, IL 61550
Phone (309) 263-2424

435 Maxine Dr
Morton, IL 61550
Phone (309) 263-2424

815 Main St
Ste A1
Peoria, IL 61602

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195

5401 N Knoxville Ave
Ste 204
Peoria, IL 61614
Phone (309) 683-1200

5401 N Knoxville Ave
Ste 400
Peoria, IL 61614
Phone (309) 691-6610

815 Main St
Ste A
Peoria, IL 61602
Phone (309) 672-4986

2806 N Knoxville Ave
Peoria, IL 61604
Phone (309) 655-6961

3915 Barring Trce
Peoria, IL 61615
Phone (309) 689-3030

8914 N Knoxville Ave
Peoria, IL 61615
Phone (309) 691-9110

1120 E War Memorial Dr
Peoria Hts, IL 61616
Phone (309) 685-1774

Organizations & group practices 8

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": "1471219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571875200000",
    "number": "1083168447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "435 MAXINE DRIVE SUITE #4",
            "city": "MORTON",
            "state": "IL",
            "postal_code": "61550",
            "telephone_number": "309-263-2424",
            "fax_number": "309-284-2244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 MAXINE DRIVE SUITE #4",
            "city": "MORTON",
            "state": "IL",
            "postal_code": "61550",
            "telephone_number": "309-263-2424",
            "fax_number": "309-284-2244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MERILA",
        "first_name": "KATHERINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-15",
        "last_updated": "2019-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209014554",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHERIN",
            "last_name": "VARNEY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Morton, IL

Sources for this page

Verify at the official NPI Registry.