Individual provider Active NPI

Shelby Laine Fehr, APRN

  • Family Nurse Practitioner
  • Peoria, IL
National Provider Identifier
1184190613
Registry record updated Oct 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209.018341 Issued in IL
Practice address
815 Main St
Peoria, IL 61602-1076
Phone
(309) 672-4977
NPI assigned
Oct 23, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 041.411087 IL
Family Nurse Practitioner 363LF0000X 209.018341 IL Primary

Addresses

Primary practice location

815 Main St
Peoria, IL 61602-1076

Mailing address

816 Kickapoo Dr
Danvers, IL 61732-9047
Phone (309) 212-4214

Other names 1

  • Miss Shelby Koehl 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
I20190201000170 IL Practitioner - Nurse Practitioner 0244577005 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Koch Family Medicine SCGroup PAC ID 1153378229, 8 clinicians

Practice addresses (Care Compare)

411 Maxine Dr
Morton, IL 61550-2495
Phone (309) 263-2411

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.74 of 100Reported as group
Quality
74.86
Improvement activities
40
Cost
79.33

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
041.411087ILMDRegistered Nurse
209.018341ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Koch Family Medicine SC CurrentSince Aug 26, 2024 Accepting new patients
Methodist Medical Center of Illinois Family CurrentSince Jan 7, 2019 Accepting new patients
Methodist Medical Center of Illinois Current Accepting new patients
Methodist Medical Center of Illinois CurrentSince Jan 7, 2019 Accepting new patients

Locations

1909 N Morton Ave
Morton, IL 61550
Phone (309) 263-9124

411 Maxine Dr
Morton, IL 61550
Phone (309) 263-2411

112 NE Crescent Ave
Peoria, IL 61606
Phone (309) 680-2402

815 Main St
Peoria, IL 61602
Phone (309) 672-4908

221 NE Glen Oak Ave
Peoria, IL 61636
Phone (309) 672-4281

815 Main St
Ste A
Peoria, IL 61602
Phone (309) 672-4986

Organizations & group practices 4

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": "1540252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540252800000",
    "number": "1184190613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "816 KICKAPOO DR",
            "city": "DANVERS",
            "state": "IL",
            "postal_code": "617329047",
            "telephone_number": "309-212-4214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 MAIN ST",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616021076",
            "telephone_number": "309-672-4977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEHR",
        "first_name": "SHELBY",
        "middle_name": "LAINE",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-23",
        "last_updated": "2018-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041.411087",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.018341",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHELBY",
            "last_name": "KOEHL",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.