Individual provider Active NPI

Jessica M Stewart, CNS

  • Clinical Nurse Specialist
  • Peoria, IL
National Provider Identifier
1104103670
Registry record updated Oct 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Nurse SpecialistTaxonomy code 364S00000X
License
2029009235 Issued in IL
Practice address
8940 N Wood Sage Rd
Peoria, IL 61615-7822
Phone
(309) 243-3000
Fax
(309) 243-3215
NPI assigned
Nov 10, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 4, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Clinical Nurse Specialist 364SA2200X 209009235 IL
Clinical Nurse Specialist 364S00000X 2029009235 IL Primary

Addresses

Primary practice location

8940 N Wood Sage Rd
Peoria, IL 61615-7822

Mailing address

8940 N Wood Sage Rd
Peoria, IL 61615-7822
Phone (309) 243-3000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, NC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20130531000535 IL Practitioner - Certified Clinical Nurse Specialist (CNS) 0840438966 Reassigns benefits to 1 organization
I20250114002722 NC Practitioner - Certified Clinical Nurse Specialist (CNS) 0840438966 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Specialist

State licenses

LicenseStateTypeSpecialty
578NCMDAcupuncturist
2029009235ILMDClinical Nurse Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Central Illinois Pathology, SC Current Accepting new patients
Saint Francis Medical Center Current Accepting new patients
Saint Francis Medical Center CurrentSince Dec 1, 2013 Accepting new patients
Wakemed Specialists Group, LLC Current Accepting new patients
Saint Francis Medical Center Clinical Nurse Specialist CurrentSince Dec 1, 2013 Accepting new patients
Wakemed Specialists Group LLC CurrentSince Jan 25, 2025 Accepting new patients
Wakemed Specialists Group, LLC CurrentSince Jan 25, 2025 Accepting new patients

Locations

530 NE Glen Oak Ave
Peoria, IL 61637
Phone (309) 655-2553

3000 New Bern Ave
Raleigh, NC 27610
Phone (919) 350-7000

23 Sunnybrook Rd
Raleigh, NC 27610
Phone (919) 322-4800

Organizations & group practices 7

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": "1320883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696377600000",
    "number": "1104103670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8940 N WOOD SAGE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616157822",
            "telephone_number": "309-243-3000",
            "fax_number": "309-243-3215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8940 N WOOD SAGE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616157822",
            "telephone_number": "309-243-3000",
            "fax_number": "309-243-3215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEWART",
        "first_name": "JESSICA",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "CNS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-11-10",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SA2200X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Adult Health",
            "state": "IL",
            "license": "209009235",
            "primary": false
        },
        {
            "code": "364S00000X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist",
            "state": "IL",
            "license": "2029009235",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.