Debra Herz, FNP-BC
Individual provider Active NPI Family Nurse Practitioner · Peru, IL
NPI 1275842650 · NPPES record last updated Mar 23, 2011
Key facts
- NPI
- 1275842650
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 209.008267 (IL)
- Practice address
- 1650 Midtown Rd
Peru, IL 61354-1274 - Phone
- (815) 223-2808
- Fax
- (815) 220-2691
- NPI assigned
- Oct 1, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 11
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mendota Community Hospital
Practice addresses (Care Compare)
1405 E 12TH St
Suite 600
Mendota, IL 61342-9012
Phone (815) 538-7200
Hospital & facility affiliations
- Osf Saint Elizabeth MDL Ctr
- Osf Saint Paul Medical Center
- Osf Saint Clare Medical Center
- Saint Francis Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110223000496 | IL | Practitioner - Nurse Practitioner | 6608057740 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209.008267 | IL | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mendota Community Hospital | Current |
Accepting new patients | |
| Mendota Community Hospital | Current | Accepting new patients | |
| Mendota Community Hospital | Current |
Accepting new patients | |
| Osf Multi-Specialty Group | Past | Accepting new patients |
Locations
1405 E 12th St
Ste 600
Mendota, IL 61342
Phone (815) 538-7200
1405 E 12th St
Ste 300
Mendota, IL 61342
Phone (815) 538-7200
1404 Washington St
Mendota, IL 61342
Phone (815) 538-1825
124 SW Adams St
Peoria, IL 61602
Phone (309) 655-2850
1650 Midtown Rd
Peru, IL 61354
Phone (815) 220-1122
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 209.008267 | IL | Yes |
Addresses
Primary practice location
1650 Midtown Rd
Peru, IL 61354-1274
Mailing address
1650 Midtown Rd
Peru, IL 61354-1274
Phone (815) 223-2808
Other providers in Peru, IL
- Health and Safety International, Inc
- Mark Alan Henry
- Heritage Manor - Peru, LLC
- Heritage Manor - Peru, LLC
- Kendra Renee Herman
- Andrea Elizabeth Heslet
- Highland Park CVS LLC
- Highland Park CVS LLC
- Shannon Lynn Hiller
- Hines Vamc
All providers in Peru, IL · Family Nurse Practitioner in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 23, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.