Individual provider Active NPI

Deanna J Schroeder, FNP-BC

  • Family Nurse Practitioner
  • Kankakee, IL
National Provider Identifier
1265523906
Registry record updated Mar 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209.001021 Issued in IL
Practice address
375 N Wall St Ste P310
Kankakee, IL 60901-3484
Phone
(815) 933-0194
Fax
(815) 936-3847
NPI assigned
Sep 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2021

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 209.001021 IL Primary

Addresses

Primary practice location

375 N Wall St Ste P310
Kankakee, IL 60901-3484

Mailing address

375 N Wall St Ste P310
Kankakee, IL 60901-3484
Phone (815) 933-0194

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dschroeder7820@Direct.riversidehealthcare.net 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
I20130515000456 IL Practitioner - Nurse Practitioner 3476790262 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Riverside Health SystemGroup PAC ID 3274434717, 202 clinicians

Practice addresses (Care Compare)

375 N Wall St
P520
Kankakee, IL 60901-3493
Phone (815) 933-0194

Hospital & facility affiliations

  • Riverside Medical Center Hospital, Kankakee, IL, CCN 140186

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209.001021ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Riverside Health System CurrentSince Feb 16, 2015 Accepting new patients
Riverside Health System CurrentSince Feb 16, 2015 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

300 Riverside Dr
Ste 2100
Bourbonnais, IL 60914
Phone (815) 928-9666

720 S Crescent St
Gilman, IL 60938
Phone (815) 265-4255

375 N Wall St
Ste P310
Kankakee, IL 60901
Phone (815) 933-0194

350 N Wall St
Kankakee, IL 60901
Phone (815) 935-7500

375 N Wall St
Ste P520
Kankakee, IL 60901
Phone (815) 933-0194

611 S Division St
Peotone, IL 60468
Phone (708) 258-9058

105 S First St
Wilmington, IL 60481
Phone (815) 476-5210

Interoperability endpoints

  • Direct secure messaging: dschroeder7820@direct.riversidehealthcare.net

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616976000000",
    "number": "1265523906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 N WALL ST STE P310",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609013484",
            "telephone_number": "815-933-0194",
            "fax_number": "815-936-3847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 N WALL ST STE P310",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609013484",
            "telephone_number": "815-933-0194",
            "fax_number": "815-936-3847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHROEDER",
        "first_name": "DEANNA",
        "middle_name": "J",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-27",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.001021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dschroeder7820@Direct.riversidehealthcare.net",
            "affiliation": "N",
            "endpointDescription": "Direct, Secure Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "375 N Wall St Ste P310",
            "city": "Kankakee",
            "state": "IL",
            "country_code": "US",
            "postal_code": "609013484",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kankakee, IL

Sources for this page

Verify at the official NPI Registry.