NPIMap

Individual provider Active NPI

Mike S Davenport, FNP

  • Nurse Practitioner
  • McLeansboro, IL
National Provider Identifier
1295789576
Registry record updated Apr 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209.005569 Issued in IL
Practice address
206 S Washington St
MC Leansboro, IL 62859-1139
Phone
(618) 643-2835
Fax
(618) 643-2891
NPI assigned
May 20, 2006
Last updated
Apr 22, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2022

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 209.005569 IL
Nurse Practitioner 363L00000X 209.005569 IL Primary

Addresses

Primary practice location

206 S Washington St
MC Leansboro, IL 62859-1139

Mailing address

206 S Washington St
MC Leansboro, IL 62859-1139
Phone (618) 643-2835

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051222000477 IL Practitioner - Nurse Practitioner 2062434616 Reassigns benefits to 2 organizations

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
Eldorado Emergency Group PCGroup PAC ID 3678955028, 14 clinicians

Practice addresses (Care Compare)

1201 Pine St
Eldorado, IL 62930-1634
Phone (618) 273-3361

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.05 of 100Reported as apm
Quality
72.1
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
98.25 of 100Reported as group
Quality
100
Improvement activities
40
Cost
73.66

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209.005569ILMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ferrell Hospital Community Foundation Family Medicine CurrentSince Apr 28, 2022 Accepting new patients
Ferrell Hospital Community Foundation Current Accepting new patients
Eldorado Emergency Group PC Nurse Practitioner CurrentSince Mar 15, 2024 Accepting new patients
Crossroads Physicians Corp Family Medicine Past Accepting new patients
Ferrell Hospital Community Foundation Past Accepting new patients

Locations

1201 Pine St
Eldorado, IL 62930
Phone (618) 273-3361

1306 Maple St
Eldorado, IL 62930
Phone (618) 273-2360

250 Small St
Harrisburg, IL 62946
Phone (618) 252-4000

Interoperability endpoints

  • Direct secure messaging: mdavenport85928@direct.deaconess.com

Organizations & group practices 5

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 7

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": "1148083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650585600000",
    "number": "1295789576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 S WASHINGTON ST",
            "city": "MC LEANSBORO",
            "state": "IL",
            "postal_code": "628591139",
            "telephone_number": "618-643-2835",
            "fax_number": "618-643-2891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 S WASHINGTON ST",
            "city": "MC LEANSBORO",
            "state": "IL",
            "postal_code": "628591139",
            "telephone_number": "618-643-2835",
            "fax_number": "618-643-2891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVENPORT",
        "first_name": "MIKE",
        "middle_name": "S",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-20",
        "last_updated": "2022-04-22",
        "certification_date": "2022-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.005569",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209.005569",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McLeansboro, IL

Sources for this page

Verify at the official NPI Registry.