Individual provider Active NPI

Heidi L Gendron, APN

  • Family Nurse Practitioner
  • Peoria, IL
National Provider Identifier
1295280303
Registry record updated Jun 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209014710 Issued in IL
Practice address
5114 N Glen Park Place Rd
Peoria, IL 61614-4686
Phone
(309) 683-8108
NPI assigned
Aug 18, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2025

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 209014710 IL Primary

Addresses

Primary practice location

5114 N Glen Park Place Rd
Peoria, IL 61614-4686

Mailing address

5114 N Glen Park Place Rd
Peoria, IL 61614-4686
Phone (309) 683-8108

Other names 1

  • Heidi L Fontaine 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
I20160901001631 IL Practitioner - Nurse Practitioner 3870889710 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

2265 W Altorfer Dr
Peoria, IL 61615-1807
Phone (309) 683-7848

Hospital & facility affiliations

  • St Joseph Medical Center Hospital, Bloomington, IL, CCN 140162

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209014710ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Osf Multi-Specialty Group CurrentSince Oct 9, 2016 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients

Locations

2200 E Washington St
Bloomington, IL 61701
Phone (309) 662-3311

2265 W Altorfer Dr
Peoria, IL 61615
Phone (309) 370-9323

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

5114 N Glen Park Place Rd
Peoria, IL 61614
Phone (309) 655-2431

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 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": "1471478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750032000000",
    "number": "1295280303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5114 N GLEN PARK PLACE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144686",
            "telephone_number": "309-683-8108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5114 N GLEN PARK PLACE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144686",
            "telephone_number": "309-683-8108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GENDRON",
        "first_name": "HEIDI",
        "middle_name": "L",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-18",
        "last_updated": "2025-06-16",
        "certification_date": "2025-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209014710",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HEIDI",
            "last_name": "FONTAINE",
            "middle_name": "L",
            "credential": "APN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.