Deidra Diane Anderson, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209026249 Issued in IL

Practice address

133 Spinder Dr
East Peoria, IL 61611-0016

Phone

(309) 308-5100

NPI assigned

Sep 14, 2022

Last updated

Oct 26, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Graham Hospital AssociationGroup PAC ID 2769375021, 124 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Graham Hospital Association Hospital, Canton, IL, CCN 140001

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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

• Graham Hospital Association

  • Critical Access Hospital
  • Canton, IL
  • NPI 1780692087
  Medicare reassignment Care Compare group NPD
• Graham Hospital Association

  dba Graham Medical Group Galesburg

  • Rural Health Clinic/Center
  • Galesburg, IL
  • NPI 1194462101
  NPD
• Graham Hospital Association

  dba Knox & Fulton County Wound and Hyperbaric Medicine

  • Internal Medicine Physician
  • Galesburg, IL
  • NPI 1710845854
  NPD

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

{
    "created_epoch": "1663113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666742400000",
    "number": "1083336234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "896 BANTA RD",
            "city": "LOWPOINT",
            "state": "IL",
            "postal_code": "615457580",
            "telephone_number": "309-208-2935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 SPINDER DR",
            "city": "EAST PEORIA",
            "state": "IL",
            "postal_code": "616110016",
            "telephone_number": "309-308-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "DEIDRA",
        "middle_name": "DIANE",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-14",
        "last_updated": "2022-10-26",
        "certification_date": "2022-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209026249",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elmira Akama, LMT
• Jessica K Albert, APRN
• Tao Marie Albritton
• Jennifer Christine Alexander, APN, PMHNP
• Christina Anderson
• Lyndon Andrews
• Henry C Anyanabor
• Jayne Armitage-Terrian
• Kwame Asante Ababio, DMD
• Associated Hearing AIDS of Peoria (Miracle Ear Centers)

• Family Nurse Practitioner in East Peoria, IL
• Providers in East Peoria, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.