Individual provider Active NPI

Melinda Lucille Lange, ADVANCED PRACTICENUR

  • Adult Health Clinical Nurse Specialist
  • Peoria, IL
National Provider Identifier
1285045013
Registry record updated May 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Clinical Nurse SpecialistTaxonomy code 364SA2200X
License
209011332 Issued in IL
Practice address
530 NE Glen Oak Ave
Peoria, IL 61637-0001
Phone
(309) 655-2000
NPI assigned
May 14, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 14, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Clinical Nurse Specialist 364SA2200X 209011332 IL Primary

Addresses

Primary practice location

530 NE Glen Oak Ave
Peoria, IL 61637-0001

Mailing address

104 Barbara St
East Peoria, IL 61611-4591
Phone (309) 258-1783

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
I20150225000690 IL Practitioner - Certified Clinical Nurse Specialist (CNS) 1658697339 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Clinical Nurse Specialist (CNS)
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Saint Francis Medical CenterGroup PAC ID 9032021258, 18 clinicians

Practice addresses (Care Compare)

530 NE Glen Oak Ave
Peoria, IL 61637-0001
Phone (309) 655-2000

Hospital & facility affiliations

  • Saint Francis Medical Center Hospital, Peoria, IL, CCN 140067
  • St Joseph Medical Center Hospital, Bloomington, IL, CCN 140162

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Francis Medical Center Current Accepting new patients
Saint Francis Medical Center CurrentSince Sep 2, 2014 Accepting new patients
Saint Francis Medical Center CurrentSince Sep 2, 2014 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

124 SW Adams St
Peoria, IL 61602
Phone (309) 655-2850

530 NE Glen Oak Ave
Peoria, IL 61637
Phone (309) 655-2553

530neglen Oak Ave
Peoria, IL 61637
Phone (309) 692-5393

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.

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": "1400025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400025600000",
    "number": "1285045013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 BARBARA ST",
            "city": "EAST PEORIA",
            "state": "IL",
            "postal_code": "616114591",
            "telephone_number": "309-258-1783",
            "fax_number": "309-282-1609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616370001",
            "telephone_number": "309-655-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANGE",
        "first_name": "MELINDA",
        "middle_name": "LUCILLE",
        "name_prefix": "Miss",
        "credential": "ADVANCED PRACTICENUR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-05-14",
        "last_updated": "2014-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SA2200X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Adult Health",
            "state": "IL",
            "license": "209011332",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.