Individual provider Active NPI

Jessica Marie Embry, APN

  • Family Nurse Practitioner
  • Peoria, IL
National Provider Identifier
1114443769
Registry record updated Aug 16, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209.016328 Issued in IL
Practice address
530 NE Glen Oak Ave
Peoria, IL 61637-0001
Phone
(309) 655-2000
NPI assigned
Aug 16, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2017

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 209.016328 IL Primary

Addresses

Primary practice location

530 NE Glen Oak Ave
Peoria, IL 61637-0001

Mailing address

112 Giles Dr
Mackinaw, IL 61755-7508
Phone (309) 635-2663

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
I20190516002173 IL Practitioner - Nurse Practitioner 0143563072 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209.016328ILMDFamily 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 Apr 10, 2019 Accepting new patients
Board of Trustees of the University of Illinois CurrentSince Apr 10, 2019 Accepting new patients

Locations

7694 Solutions Ctr
Chicago, IL 60677

420 NE Glen Oak Ave
Peoria, IL 61603
Phone (309) 655-2343

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

1 Illini Dr
Peoria, IL 61605
Phone (309) 671-3000

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 and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1502841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1502841600000",
    "number": "1114443769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 GILES DR",
            "city": "MACKINAW",
            "state": "IL",
            "postal_code": "617557508",
            "telephone_number": "309-635-2663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616370001",
            "telephone_number": "309-655-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EMBRY",
        "first_name": "JESSICA",
        "middle_name": "MARIE",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-16",
        "last_updated": "2017-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.016328",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.