Individual provider Active NPI

Lainey Jean Brown, FNP

  • Nurse Practitioner
  • Belleville, IL
National Provider Identifier
1265182786
Registry record updated Oct 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209027811 Issued in IL
Practice address
4700 Memorial Dr Ste 210
Belleville, IL 62226-5373
Phone
(618) 767-7700
NPI assigned
Mar 27, 2022
Last updated
Oct 6, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 209027811 IL Primary
Family Nurse Practitioner 363LF0000X 209027811 IL

Addresses

Primary practice location

4700 Memorial Dr Ste 210
Belleville, IL 62226-5373

Mailing address

4700 Memorial Dr Ste 210
Belleville, IL 62226-5373
Phone (618) 767-7700

Other practice location 1

600 Moye Blvd
Greenville, NC 27834-4300
Phone (252) 744-6478

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Direct

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
I20230911002922 IL Practitioner - Nurse Practitioner 9234593112 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
Telehealth
Offers telehealth services
Group practices
Fairview Heights Medical Group SCGroup PAC ID 6800784083, 448 clinicians

Practice addresses (Care Compare)

4700 Memorial Dr
Suite 210
Belleville, IL 62226-5373
Phone (618) 767-7700

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209027811ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Heights Medical Group SC CurrentSince Sep 1, 2023 Accepting new patients
Fairview Heights Medical Group SC CurrentSince Sep 1, 2023 Accepting new patients

Locations

1 Memorial Dr
Alton, IL 62002
Phone (618) 463-7240

4700 Memorial Dr
Ste 210
Belleville, IL 62226
Phone (618) 235-0460

660 Mason Ridge Center Dr
Saint Louis, MO 63141
Phone (314) 273-6481

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1648339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696550400000",
    "number": "1265182786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 MEMORIAL DR STE 210",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265373",
            "telephone_number": "618-767-7700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 MEMORIAL DR STE 210",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265373",
            "telephone_number": "618-767-7700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 Moye Blvd",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "NC",
            "postal_code": "278344300",
            "country_code": "US",
            "telephone_number": "252-744-6478",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROWN",
        "first_name": "LAINEY",
        "middle_name": "JEAN",
        "name_prefix": "Ms.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-27",
        "last_updated": "2023-10-06",
        "certification_date": "2023-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209027811",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209027811",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4700 Memorial Dr Ste 210",
            "city": "Belleville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622265373",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Belleville, IL

Sources for this page

Verify at the official NPI Registry.