Individual provider Active NPI

Angela Sue Birdsell, APN

  • Family Nurse Practitioner
  • Bloomington, IL
National Provider Identifier
1306350780
Registry record updated Nov 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209016781 Issued in IL
Practice address
2406 E Empire St
Bloomington, IL 61704-3630
Phone
(309) 662-4321
Fax
(309) 663-8032
NPI assigned
Nov 21, 2017
Last updated
Nov 21, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2017

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 209016781 IL Primary

Addresses

Primary practice location

2406 E Empire St
Bloomington, IL 61704-3630

Mailing address

102 S Mary St
Atlanta, IL 61723-8993
Phone (217) 737-1694

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
I20180507000698 IL Practitioner - Nurse Practitioner 9739443375 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Decatur Memorial HospitalGroup PAC ID 6204731144, 173 clinicians

Practice addresses (Care Compare)

304 W Hay St
213 DMH Millennium Pain Center
Decatur, IL 62526-4169
Phone (217) 876-6640

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
73.88 of 100Reported as group
Quality
63.91
Improvement activities
40
Cost
77.03

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209016781ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Decatur Memorial Hospital CurrentSince Feb 26, 2023 Accepting new patients

Locations

2300 N Edward St
Decatur, IL 62526
Phone (217) 876-3000

304 W Hay St
Ste 213
Decatur, IL 62526
Phone (217) 875-1518

241 W Weaver Rd
Ste 145B
Forsyth, IL 62535
Phone (217) 876-5220

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 2

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": "1511222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1511222400000",
    "number": "1306350780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 S MARY ST",
            "city": "ATLANTA",
            "state": "IL",
            "postal_code": "617238993",
            "telephone_number": "217-737-1694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2406 E EMPIRE ST",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617043630",
            "telephone_number": "309-662-4321",
            "fax_number": "309-663-8032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BIRDSELL",
        "first_name": "ANGELA",
        "middle_name": "SUE",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-21",
        "last_updated": "2017-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209016781",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IL

Sources for this page

Verify at the official NPI Registry.