Alivia Renea Derham, APN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

209017147 Issued in IL

Practice address

3375 N Seminary St
Galesburg, IL 61401-1251

Phone

(309) 343-5114

Fax

(309) 343-7859

NPI assigned

Jan 23, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Graham Hospital AssociationGroup PAC ID 2769375021, 124 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Graham Hospital Association Hospital, Canton, IL, CCN 140001
• Graham Hospital Association Hospital, Canton, IL, CCN 141356
• MC Donough District Hospital Hospital, Macomb, IL, CCN 140089

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Graham Hospital Association

  • Critical Access Hospital
  • Canton, IL
  • NPI 1780692087
  Medicare reassignment Care Compare group NPD
• Graham Hospital Association

  dba Graham Medical Group Galesburg 2

  • Rural Health Clinic/Center
  • Galesburg, IL
  • NPI 1063128601
  NPD
• Graham Hospital Association

  dba Knox & Fulton County Wound and Hyperbaric Medicine

  • Internal Medicine Physician
  • Galesburg, IL
  • NPI 1710845854
  NPD
• St Mary Medical Center

  dba OSFMG - Galesburg

  • Family Medicine Physician
  • Galesburg, IL
  • NPI 1457308710

  Nurse Practitioner

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Graham Hospital Association

  • Critical Access Hospital
  • Canton, IL
  • NPI 1154117521
  Care Compare affiliation
• McDonough County Hospital District

  dba McDonough District Hospital

  • General Acute Care Hospital
  • Macomb, IL
  • NPI 1669420766
  Care Compare affiliation

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

{
    "created_epoch": "1516665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516665600000",
    "number": "1386142503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3375 N SEMINARY ST",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614011251",
            "telephone_number": "309-343-5114",
            "fax_number": "309-343-7859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3375 N SEMINARY ST",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614011251",
            "telephone_number": "309-343-5114",
            "fax_number": "309-343-7859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERHAM",
        "first_name": "ALIVIA",
        "middle_name": "RENEA",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-23",
        "last_updated": "2018-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209017147",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sharon K. Degroot, RN
• Jessica Dejaynes, CRNA
• Dental Group of Galesburg PLLC
• Mukund P Deoras, M.D.
• Sandra Deppe, LMT
• Nathan Curtis Dieckow, O.D.
• Karley Divan, MA, LPC
• Andre DO, PHARMD
• Jessica Donaldson
• Emily Kelly Dooley, MD

• Nurse Practitioner in Galesburg, IL
• Providers in Galesburg, IL by specialty
• Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.