Individual provider Active NPI

Jacqueline Suzanne Butler, FNP

  • Family Nurse Practitioner
  • Carmel, IN
National Provider Identifier
1083818835
Registry record updated Dec 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71002409A Issued in IN
Practice address
13250 Hazel Dell Pkwy Ste 104
Carmel, IN 46033-8527
Phone
(317) 415-6900
NPI assigned
Jun 14, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209007474 IL
Family Nurse Practitioner 363LF0000X 71002409A IN Primary

Addresses

Primary practice location

13250 Hazel Dell Pkwy Ste 104
Carmel, IN 46033-8527

Mailing address

13250 Hazel Dell Pkwy Ste 104
Carmel, IN 46033-8527

Other practice location 1

611 W Park St
Urbana, IL 61801-2501
Phone (217) 383-2410

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jacqueline.cole.2@7598.direct.athenahealth.com St. Vincent Medical Group, Inc.

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
I20091118000153 IL Practitioner - Nurse Practitioner 2860581436 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carle Health Care IncorporatedGroup PAC ID 3577515774, 1,592 clinicians

Practice addresses (Care Compare)

1701 W Curtis Rd
Champaign, IL 61822-9678
Phone (217) 365-6200

1818 E Windsor Rd
Urbana, IL 61802-9566
Phone (217) 255-9500

200 Lerna Rd S
Mattoon, IL 61938-9388
Phone (217) 258-5900

611 W Park St
Urbana, IL 61801-2500

611 W Park St
Urbana, IL 61801-2501
Phone (888) 712-2753

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
71002409AINMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Hoopeston Community Memorial Hospital CurrentSince Dec 18, 2023 Accepting new patients
Carle Health Care Incorporated CurrentSince Dec 18, 2023 Accepting new patients
Hoopeston Community Memorial Hospital Current Accepting new patients
Hoopeston Community Memorial Hospital Current Accepting new patients
Carle Health Care Incorporated Past Accepting new patients

Locations

3310 Fields South Dr
Champaign, IL 61822
Phone (217) 417-2352

1701 Curtis Rd
Champaign, IL 61822
Phone (217) 365-6201

701 E Orange St
Hoopeston, IL 60942
Phone (217) 283-5531

2512 Hurst Dr
Mattoon, IL 61938
Phone (217) 258-5900

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

1818 E Windsor Rd
Urbana, IL 61802
Phone (217) 255-9646

Interoperability endpoints

  • Direct secure messaging: jacqueline.cole.3@7598.direct.athenahealth.com
  • Direct secure messaging: jacqueline.cole.2@7598.direct.athenahealth.com
  • Direct secure messaging: jcole402571@carlehiedirect.net

Organizations & group practices 6

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 2

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": "1181779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733702400000",
    "number": "1083818835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13250 HAZEL DELL PKWY STE 104",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460338527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13250 HAZEL DELL PKWY STE 104",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460338527",
            "telephone_number": "317-415-6900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "611 W Park St",
            "address_purpose": "LOCATION",
            "city": "Urbana",
            "state": "IL",
            "postal_code": "618012501",
            "country_code": "US",
            "telephone_number": "217-383-2410",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUTLER",
        "first_name": "JACQUELINE",
        "middle_name": "SUZANNE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-14",
        "last_updated": "2024-12-09",
        "certification_date": "2024-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209007474",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71002409A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jacqueline.cole.2@7598.direct.athenahealth.com",
            "affiliation": "Y",
            "affiliationName": "St. Vincent Medical Group, Inc.",
            "address_1": "590 Pit Rd",
            "city": "Brownsburg",
            "state": "IN",
            "country_code": "US",
            "postal_code": "461127830",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Carmel, IN

Sources for this page

Verify at the official NPI Registry.