NPIMap

Individual provider Active NPI

Shanna Witges, APRN NP-C

  • Nurse Practitioner
  • Waterloo, IL
National Provider Identifier
1376882647
Registry record updated Jan 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
277000985 Issued in IL
Practice address
509 Hamacher St Ste 102
Waterloo, IL 62298-1592
Phone
(618) 939-3939
NPI assigned
Feb 6, 2013
Last updated
Jan 26, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2023

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 2013002942 MO
Nurse Practitioner 363L00000X 277000985 IL Primary

Addresses

Primary practice location

509 Hamacher St Ste 102
Waterloo, IL 62298-1592

Mailing address

509 Hamacher St
Suite 102
Waterloo, IL 62298-1592
Phone (618) 939-3939

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
I20131108000567 IL Practitioner - Nurse Practitioner 0345486445 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Deaconess Illinois Clinic IncGroup PAC ID 5092187021, 19 clinicians

Practice addresses (Care Compare)

1000 Eleven S
Columbia, IL 62236-1077
Phone (618) 939-2273

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.16 of 100Reported as group
Quality
70.69
Promoting interoperability
99
Improvement activities
40
Cost
71.02

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2013002942MOMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Deaconess Illinois Clinic, Inc Nurse Practitioner CurrentSince Jan 14, 2023 Accepting new patients
Deaconess Illinois Clinic, Inc Nurse Practitioner CurrentSince Jan 14, 2023 Accepting new patients
Deaconess Illinois Clinic, Inc Nurse Practitioner Current Accepting new patients
Deaconess Illinois Clinic, Inc Nurse Practitioner Past Accepting new patients
Heartland Rural Healthcare, LLC Past Accepting new patients
Sparta Community Hospital PastSince Nov 9, 2025 Accepting new patients
Sparta Community Hospital Past Accepting new patients
Family Practice Associates, PC Past Accepting new patients

Locations

205 Bailey Ln
Benton, IL 62812
Phone (618) 435-8189

1000 Eleven S
Columbia, IL 62236
Phone (618) 281-7010

1000 Eleven S
Ste 2E
Columbia, IL 62236
Phone (618) 206-6120

1000 Eleven S
Ste 2F
Columbia, IL 62236
Phone (618) 281-9300

509 Hamacher St
Waterloo, IL 62298
Phone (618) 939-3939

509 Hamacher St
Ste 102
Waterloo, IL 62298
Phone (618) 798-8405

509 Hamacher St
Ste 103
Waterloo, IL 62298
Phone (618) 939-2273

Interoperability endpoints

  • Direct secure messaging: shanna.witges.1@27782.direct.athenahealth.com

Organizations & group practices 8

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 4

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": "1360108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674691200000",
    "number": "1376882647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 HAMACHER ST",
            "address_2": "SUITE 102",
            "city": "WATERLOO",
            "state": "IL",
            "postal_code": "622981592",
            "telephone_number": "618-939-3939",
            "fax_number": "618-939-3941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 HAMACHER ST STE 102",
            "city": "WATERLOO",
            "state": "IL",
            "postal_code": "622981592",
            "telephone_number": "618-939-3939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITGES",
        "first_name": "SHANNA",
        "credential": "APRN NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-06",
        "last_updated": "2023-01-26",
        "certification_date": "2023-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2013002942",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "277000985",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterloo, IL

Sources for this page

Verify at the official NPI Registry.