Individual provider Active NPI

Matthew Evan Guimond, NP

  • Family Nurse Practitioner
  • Kankakee, IL
National Provider Identifier
1295416543
Registry record updated Sep 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209030426 Issued in IL
Practice address
375 N Wall St Ste P510
Kankakee, IL 60901-3492
Phone
(815) 935-0750
NPI assigned
Jul 28, 2023
Last updated
Sep 11, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209030426 IL Primary
Neuroscience Registered Nurse 163WN0800X 041467924 IL

Addresses

Primary practice location

375 N Wall St Ste P510
Kankakee, IL 60901-3492

Mailing address

375 N Wall St Ste P510
Kankakee, IL 60901-3492
Phone (815) 935-0750

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
I20240919000121 IL Practitioner - Nurse Practitioner 5092256909 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
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)

105 S 1St St
Willmington, IL 60481-8973
Phone (815) 476-5210

350 N Wall St 4TH Floor
Kankakee, IL 60901-2901
Phone 81593316714592

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

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
041467924ILMDNeuroscience Registered Nurse
209030426ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Riverside Health System CurrentSince Sep 5, 2024 Accepting new patients
Riverside Health System CurrentSince Sep 5, 2024 Accepting new patients

Locations

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

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

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.

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": "1690502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726012800000",
    "number": "1295416543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 N WALL ST STE P510",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609013492",
            "telephone_number": "815-935-0750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 N WALL ST STE P510",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609013492",
            "telephone_number": "815-935-0750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUIMOND",
        "first_name": "MATTHEW",
        "middle_name": "EVAN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-07-28",
        "last_updated": "2024-09-11",
        "certification_date": "2024-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209030426",
            "primary": true
        },
        {
            "code": "163WN0800X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Neuroscience",
            "state": "IL",
            "license": "041467924",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kankakee, IL

Sources for this page

Verify at the official NPI Registry.