Individual provider Active NPI

Rebecca Elizabeth Renfroe, NP

  • Nurse Practitioner
  • Carbondale, IL
National Provider Identifier
1093450728
Registry record updated Feb 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209023102 Issued in IL
Practice address
305 W Jackson St Ste 206
Carbondale, IL 62901-1474
Phone
(618) 457-3031
Fax
(618) 457-3032
NPI assigned
Apr 27, 2022
Last updated
Feb 6, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2025

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 209023102 IL Primary

Addresses

Primary practice location

305 W Jackson St Ste 206
Carbondale, IL 62901-1474

Mailing address

PO Box 3988
Carbondale, IL 62902-3988
Phone (618) 457-5200

Other practice location 1

405 W Jackson St
Carbondale, IL 62901-1467
Phone (618) 549-0721

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rrenfroe24793@sih.direct-ci.com

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
I20221010001169 IL Practitioner - Nurse Practitioner 9032595335 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

305 W Jackson St
Suite 206
Carbondale, IL 62901-1474
Phone (618) 457-3006

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.05 of 100Reported as apm
Quality
72.1
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209023102ILMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Illinois Medical Services, NFP CurrentSince Feb 19, 2024 Accepting new patients
RLH Urology Locum Services LLC CurrentSince Apr 17, 2023 Accepting new patients

Locations

2601 W Main St
Carbondale, IL 62901
Phone (618) 351-7300

305 W Jackson St
Ste 206
Carbondale, IL 62901
Phone (618) 457-3006

405 W Jackson St
Carbondale, IL 62901

3401 Heartland St
Marion, IL 62959
Phone (618) 998-8500

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/25412/brand/1/csg/1/fhir/r4
  • Direct secure messaging: rrenfr01@yourcarecommunity.org

Organizations & group practices 2

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.

Hospital & facility affiliations 3

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": "1651017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738800000000",
    "number": "1093450728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3988",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629023988",
            "telephone_number": "618-457-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 W JACKSON ST STE 206",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629011474",
            "telephone_number": "618-457-3031",
            "fax_number": "618-457-3032"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "405 W Jackson St",
            "address_purpose": "LOCATION",
            "city": "Carbondale",
            "state": "IL",
            "postal_code": "629011467",
            "country_code": "US",
            "telephone_number": "618-549-0721",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RENFROE",
        "first_name": "REBECCA",
        "middle_name": "ELIZABETH",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-27",
        "last_updated": "2025-02-06",
        "certification_date": "2025-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209023102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rrenfroe24793@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "305 W Jackson St Ste 206",
            "city": "Carbondale",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629011474",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Carbondale, IL

Sources for this page

Verify at the official NPI Registry.