Individual provider Active NPI

Jenny M Daniels, FNP-BC

  • Obstetrics & Gynecology Nurse Practitioner
  • Bethalto, IL
National Provider Identifier
1346783230
Registry record updated Sep 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology Nurse PractitionerTaxonomy code 363LX0001X
License
209013936 Issued in IL
Practice address
163 E Bethalto Dr
Bethalto, IL 62010-1801
Phone
(618) 433-6640
Fax
(618) 433-6645
NPI assigned
Nov 23, 2016
Last updated
Sep 10, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 10, 2025

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 2016029268 IL
Obstetrics & Gynecology Nurse Practitioner 363LX0001X 209013936 IL Primary

Addresses

Primary practice location

163 E Bethalto Dr
Bethalto, IL 62010-1801

Mailing address

163 E Bethalto Dr
Bethalto, IL 62010-1801
Phone (618) 288-7408

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)

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
I20200623000225 IL Practitioner - Nurse Practitioner 1456638048 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anderson Medical Group LLCGroup PAC ID 5193792018, 136 clinicians

Practice addresses (Care Compare)

6810 State Route 162
Suite 105
Maryville, IL 62062-8560
Phone (618) 288-9320

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2016029268ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Heights Medical Group SC CurrentSince Jun 1, 2020 Accepting new patients
Fairview Heights Medical Group SC CurrentSince Jun 1, 2020 Accepting new patients
Anderson Medical Group, LLC CurrentSince Dec 1, 2023 Accepting new patients

Locations

1 Memorial Dr
Alton, IL 62002
Phone (618) 463-7240

163 E Bethalto Dr
Bethalto, IL 62010
Phone (618) 433-6490

6810 State Route 162
Ste 105
Maryville, IL 62062
Phone (618) 288-3616

6810 State Route 162
Ste 215
Maryville, IL 62062
Phone (618) 391-6405

2630 Highway K
O Fallon, MO 63368
Phone (636) 240-5454

Organizations & group practices 3

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": "1479859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757462400000",
    "number": "1346783230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "163 E BETHALTO DR",
            "city": "BETHALTO",
            "state": "IL",
            "postal_code": "620101801",
            "telephone_number": "618-288-7408",
            "fax_number": "618-288-7418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "163 E BETHALTO DR",
            "city": "BETHALTO",
            "state": "IL",
            "postal_code": "620101801",
            "telephone_number": "618-433-6640",
            "fax_number": "618-433-6645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DANIELS",
        "first_name": "JENNY",
        "middle_name": "M",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-11-23",
        "last_updated": "2025-09-10",
        "certification_date": "2025-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "2016029268",
            "primary": false
        },
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "IL",
            "license": "209013936",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "163 E Bethalto Dr",
            "city": "Bethalto",
            "state": "IL",
            "country_code": "US",
            "postal_code": "620101801",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bethalto, IL

Sources for this page

Verify at the official NPI Registry.