Active NPI
Renae Callahan
- Nurse Practitioner
- Morton, IL
National Provider Identifier
1164016408
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 209021136
- Practice address
- 104 E Queenwood Rd Ste 202
Morton, IL 61550-2962 - Phone
- (309) 621-9580
- NPI assigned
- Feb 26, 2021
- Last updated
- Feb 26, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 209021136 | IL | Primary |
Addresses
Primary practice location
104 E Queenwood Rd Ste 202
Morton, IL 61550-2962
Mailing address
3820 Camden Cir
Chillicothe, IL 61523-9490
Phone (309) 472-0133
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
- Opted out of Medicare
- Yes, effective May 13, 2021 through May 13, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209021136 | IL | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1614297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1614297600000",
"number": "1164016408",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3820 CAMDEN CIR",
"city": "CHILLICOTHE",
"state": "IL",
"postal_code": "615239490",
"telephone_number": "309-472-0133"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 E QUEENWOOD RD STE 202",
"city": "MORTON",
"state": "IL",
"postal_code": "615502962",
"telephone_number": "309-621-9580"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CALLAHAN",
"first_name": "RENAE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-02-26",
"last_updated": "2021-02-26",
"certification_date": "2021-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "IL",
"license": "209021136",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Morton, IL
- Jerry Christopher Bucholc, PHARM.D., BCGP
- Karen Budzinski, PTA
- Bulldog Alliance Two (Hometown Pharmacy)
- Andrew Burton, DDS
- Alyssa Nadine Caliolio
- Care Solutions of Illinois Inc (Dynamic Physical Therapy)
- Care Solutions of Illinois Inc (Care Solutions)
- Charles J Carlin, D.C
- Patrick Carr, RPH.
- CB Laboratory LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.