NPIMap

Individual provider Active NPI

Kristen Jackson, FNP-C

  • Nurse Practitioner
  • Elmwood, IL
National Provider Identifier
1316465347
Registry record updated Jul 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209016808 Issued in IL
Practice address
1024 N Magnolia St
Elmwood, IL 61529-9602
Phone
(309) 742-6334
Fax
(309) 649-6880
NPI assigned
Aug 30, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 7, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 041412141 IL
Nurse Practitioner 363L00000X 209016808 IL Primary

Addresses

Primary practice location

1024 N Magnolia St
Elmwood, IL 61529-9602

Mailing address

180 S Main St
Canton, IL 61520-2608
Phone (309) 647-0201

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kristen.jackson@gmgil.eclinicaldirectplus.com Health Information Exchange (HIE)

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
I20171201001882 IL Practitioner - Nurse Practitioner 8527325356 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Georgetown University School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Graham Hospital Association 124 clinicians

Practice addresses (Care Compare)

180 S Main St
Canton, IL 61520-2608
Phone (309) 647-0201

Hospital & facility affiliations

  • St. Francis Medical Center Home health agency, Peoria, IL, CCN 147243
  • Western Ill Home HLTH Care in Home health agency, Monmouth, IL, CCN 147204
  • Graham Hospital Association Hospital, Canton, IL, CCN 141356
  • Graham Hospital Association Hospital, Canton, IL, CCN 140001
  • Saint Francis Medical Center Hospital, Peoria, IL, CCN 140067
  • St Mary Medical Center Hospital, Galesburg, IL, CCN 140064
  • Carle Health Methodist Hospital Hospital, Peoria, IL, CCN 140209

Merit-based Incentive Payment System (MIPS)

Final score
83.26 of 100Reported as group
Quality
62.57
Promoting interoperability
100
Improvement activities
40
Cost
77.37

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
041412141ILMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Graham Hospital Association CurrentSince Apr 1, 2019 Accepting new patients
Graham Hospital Association CurrentSince Apr 1, 2019 Accepting new patients
Graham Hospital Association Past Accepting new patients

Locations

210 W Walnut St
Canton, IL 61520
Phone (309) 647-5240

175 S Main St
Canton, IL 61520
Phone (309) 647-3937

180 S Main St
Canton, IL 61520
Phone (309) 647-5240

1024 N Magnolia St
Elmwood, IL 61529
Phone (309) 742-6334

120 E Gale St
Williamsfield, IL 61489
Phone (309) 639-2233

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 5

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": "1504051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625616000000",
    "number": "1316465347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 S MAIN ST",
            "city": "CANTON",
            "state": "IL",
            "postal_code": "615202608",
            "telephone_number": "309-647-0201",
            "fax_number": "309-647-8613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1024 N MAGNOLIA ST",
            "city": "ELMWOOD",
            "state": "IL",
            "postal_code": "615299602",
            "telephone_number": "309-742-6334",
            "fax_number": "309-649-6880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KRISTEN",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-08-30",
        "last_updated": "2021-07-07",
        "certification_date": "2021-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041412141",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209016808",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kristen.jackson@gmgil.eclinicaldirectplus.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "1024 N Magnolia St",
            "city": "Elmwood",
            "state": "IL",
            "country_code": "US",
            "postal_code": "615299602",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Elmwood, IL

Sources for this page

Verify at the official NPI Registry.