Individual provider Active NPI

Summer L Park, APN

  • Family Nurse Practitioner
  • Champaign, IL
National Provider Identifier
1114196904
Registry record updated Feb 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209006933 Issued in IL
Practice address
1801 Windsor Rd
Champaign, IL 61822-6217
Phone
(217) 366-6104
Fax
(217) 366-6106
NPI assigned
Feb 26, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209006933 IL Primary

Addresses

Primary practice location

1801 Windsor Rd
Champaign, IL 61822-6217

Mailing address

101 W University Ave
Champaign, IL 61820-3909
Phone (217) 366-1326

Other practice location 1

845 S Damen Ave
Chicago, IL 60612-3727
Phone (312) 996-7416

Other names 1

  • Summer L Roeschley Former name

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
I20080318000787 IL Practitioner - Nurse Practitioner 7012093974 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

8600 State Route 91
Suite 130
Peoria, IL 61615-7829
Phone (309) 683-5050

Hospital & facility affiliations

  • Saint Francis Medical Center Hospital, Peoria, IL, CCN 140067

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209006933ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Board of Trustees of the University of Illinois Current Accepting new patients
The Board of Trustees of the University of Illinois CurrentSince Feb 29, 2024 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Sep 1, 2023 Accepting new patients
The Board of Trustees of the University of Illinois CurrentSince Feb 29, 2024 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
The Board of Trustees of the University of Illinois Past Accepting new patients
Cardinal Medical Group, LTD. Past Accepting new patients

Locations

722 W Maxwell St
#235
Chicago, IL 60607
Phone (312) 433-4114

845 S Damen Ave
Chicago, IL 60612
Phone (312) 996-0376

1855 W Taylor St
Chicago, IL 60612
Phone (312) 996-6582

7732 Solution Ctr
Chicago, IL 60677
Phone (312) 355-6290

143 Ford Ave
Hopedale, IL 61747
Phone (309) 449-3336

435 Maxine Dr
Ste 6
Morton, IL 61550

435 Maxine Dr
Ste 3
Morton, IL 61550
Phone (309) 263-2424

435 Maxine Dr
Ste 4
Morton, IL 61550
Phone (309) 263-2424

3422 Court St
#A
Pekin, IL 61554
Phone (309) 477-6000

5114 N Glen Park Place Rd
Ste 220
Peoria, IL 61614
Phone (309) 683-8100

5114 N Glen Park Place Rd
Ste 110
Peoria, IL 61614
Phone (309) 683-5600

5111 N Glen Park Place Rd
Peoria, IL 61614
Phone (309) 683-5700

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

10 Saint Clare Ct
Ste 100
Washington, IL 61571
Phone (309) 886-4000

Organizations & group practices 8

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": "1203984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738886400000",
    "number": "1114196904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 W UNIVERSITY AVE",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618203909",
            "telephone_number": "217-366-1326",
            "fax_number": "217-366-6106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 WINDSOR RD",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618226217",
            "telephone_number": "217-366-6104",
            "fax_number": "217-366-6106"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "845 S Damen Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606123727",
            "country_code": "US",
            "telephone_number": "312-996-7416",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "SUMMER",
        "middle_name": "L",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-26",
        "last_updated": "2025-02-07",
        "certification_date": "2025-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209006933",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUMMER",
            "last_name": "ROESCHLEY",
            "middle_name": "L",
            "credential": "APN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Champaign, IL

Sources for this page

Verify at the official NPI Registry.