Individual provider Active NPI

Jessica T Kunken, NP-C

  • Nurse Practitioner
  • Springfield, IL
National Provider Identifier
1326781600
Registry record updated Nov 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209.024512 Issued in IL
Practice address
751 N Rutledge St Ste 2100
Springfield, IL 62702-4968
Phone
(217) 545-8000
NPI assigned
Apr 15, 2022
Last updated
Nov 14, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 209.024512 IL Primary

Addresses

Primary practice location

751 N Rutledge St Ste 2100
Springfield, IL 62702-4968

Mailing address

201 E Madison St Ste 328
Springfield, IL 62702-5131
Phone (217) 545-8000

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
I20220510000767 IL Practitioner - Nurse Practitioner 6608253844 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Siu Physicians & Surgeons, Inc CurrentSince Jun 1, 2022 Accepting new patients
Board of Trustees of Southern Illinois University Current Accepting new patients
Siu Physicians & Surgeons, Inc CurrentSince Jun 1, 2022 Accepting new patients
Springfield Clinic, LLP PastSince Nov 20, 2022 Accepting new patients
Siu Physicians & Surgeons, Inc PastSince Aug 28, 2022 Accepting new patients

Locations

201 E Madison St
Ste 328
Springfield, IL 62702

301 N 8th St
Springfield, IL 62701
Phone (217) 545-0003

751 N Rutledge St
Springfield, IL 62702
Phone (217) 545-0182

751 N Rutledge St
Ste 1700
Springfield, IL 62702
Phone (217) 545-0182

751 N Rutledge St
Ste 2100
Springfield, IL 62702
Phone (217) 545-3787

Interoperability endpoints

  • Direct secure messaging: jessicakunken@siusm.allscriptsdirect.net

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1649980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668384000000",
    "number": "1326781600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 E MADISON ST STE 328",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627025131",
            "telephone_number": "217-545-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 N RUTLEDGE ST STE 2100",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627024968",
            "telephone_number": "217-545-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUNKEN",
        "first_name": "JESSICA",
        "middle_name": "T",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-15",
        "last_updated": "2022-11-14",
        "certification_date": "2022-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209.024512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.