Individual provider Active NPI

Jessica Norman, FNP-BC

  • Family Nurse Practitioner
  • Manteno, IL
National Provider Identifier
1104687904
Registry record updated Feb 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209029291 Issued in IL
Practice address
847 White Tail BND
Manteno, IL 60950-3724
Phone
(815) 386-0453
NPI assigned
Jan 18, 2024
Last updated
Feb 8, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 8, 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 209029291 IL Primary
Registered Nurse 163W00000X 041432637 IL

Addresses

Primary practice location

847 White Tail BND
Manteno, IL 60950-3724

Mailing address

847 White Tail BND
Manteno, IL 60950-3724
Phone (815) 386-0453

Other practice location 1

350 N Wall St
Kankakee, IL 60901-2991
Phone (815) 935-7521

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
I20240228000484 IL Practitioner - Nurse Practitioner 3779928908 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Riverside Health SystemGroup PAC ID 3274434717, 202 clinicians

Practice addresses (Care Compare)

105 S 1St St
Willmington, IL 60481-8973
Phone (815) 476-5210

350 N Wall St 4TH Floor
Kankakee, IL 60901-2901
Phone 81593316714592

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
041432637ILMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Riverside Health System CurrentSince Feb 13, 2024 Accepting new patients
Riverside Health System Current Accepting new patients
Riverside Medical Center Past Accepting new patients

Locations

300 Riverside Dr
Ste 2100
Bourbonnais, IL 60914
Phone (815) 928-9666

350 N Wall St
Kankakee, IL 60901
Phone (815) 935-7500

105 S First St
Wilmington, IL 60481
Phone (815) 476-5210

Organizations & group practices 3

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 1

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": "1705536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707350400000",
    "number": "1104687904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "847 WHITE TAIL BND",
            "city": "MANTENO",
            "state": "IL",
            "postal_code": "609503724",
            "telephone_number": "815-386-0453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "847 WHITE TAIL BND",
            "city": "MANTENO",
            "state": "IL",
            "postal_code": "609503724",
            "telephone_number": "815-386-0453"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "350 N Wall St",
            "address_purpose": "LOCATION",
            "city": "Kankakee",
            "state": "IL",
            "postal_code": "609012991",
            "country_code": "US",
            "telephone_number": "815-935-7521",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NORMAN",
        "first_name": "JESSICA",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-18",
        "last_updated": "2024-02-08",
        "certification_date": "2024-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209029291",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041432637",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manteno, IL

Sources for this page

Verify at the official NPI Registry.