Individual provider Active NPI

Brandon N. Nierhoff, APN

  • Nurse Practitioner
  • Loves Park, IL
National Provider Identifier
1093233173
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209016528 Issued in IL
Practice address
9951 Rock Cut Xing
Loves Park, IL 61111-1999
Phone
(815) 639-8500
Fax
(815) 639-8501
NPI assigned
Sep 8, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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 209016528 IL Primary

Addresses

Primary practice location

9951 Rock Cut Xing
Loves Park, IL 61111-1999

Mailing address

9951 Rock Cut Xing
Loves Park, IL 61111-1999
Phone (815) 639-8500

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
I20171108002462 IL Practitioner - Nurse Practitioner 1759647605 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209016528ILMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Anthony Medical Center CurrentSince May 15, 2023 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Sep 19, 2017 Accepting new patients
Saint Anthony Medical Center CurrentSince May 15, 2023 Accepting new patients

Locations

9951 Rock Cut Xing
Loves Park, IL 61111
Phone (815) 639-8450

124 SW Adams St
Fl 2
Peoria, IL 61602
Phone (309) 655-2850

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

5666 E State St
Rockford, IL 61108
Phone (815) 226-2000

1502 Parkview Ave
Rockford, IL 61107
Phone (815) 381-7250

Organizations & group practices 4

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": "1504828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1093233173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9951 ROCK CUT XING",
            "city": "LOVES PARK",
            "state": "IL",
            "postal_code": "611111999",
            "telephone_number": "815-639-8500",
            "fax_number": "815-639-8501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9951 ROCK CUT XING",
            "city": "LOVES PARK",
            "state": "IL",
            "postal_code": "611111999",
            "telephone_number": "815-639-8500",
            "fax_number": "815-639-8501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIERHOFF",
        "first_name": "BRANDON",
        "middle_name": "N.",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-08",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209016528",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loves Park, IL

Sources for this page

Verify at the official NPI Registry.