Individual provider Active NPI

Amy Zimmerman, APN

  • Pediatric Clinical Nurse Specialist
  • Peoria, IL
National Provider Identifier
1396183786
Registry record updated Jun 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Clinical Nurse SpecialistTaxonomy code 364SP0200X
License
209009987 Issued in IL
Practice address
507 E Armstrong Ave
Peoria, IL 61603-3201
Phone
(309) 681-6960
NPI assigned
Jun 7, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Clinical Nurse Specialist 364SP0200X 209009987 IL Primary

Addresses

Primary practice location

507 E Armstrong Ave
Peoria, IL 61603-3201

Mailing address

507 E Armstrong Ave
Peoria, IL 61603-3201
Phone (309) 681-6960

Other identifiers 1

IdentifierTypeStateIssuer
376000511MedicaidIL

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
I20130718000287 IL Practitioner - Nurse Practitioner 0749421642 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209009987ILMDPediatric Clinical Nurse Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
The Board of Trustees of the University of Illinois Current Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Sep 1, 2025 Accepting new patients
Board of Trustees of the University of Illinois CurrentSince Jun 3, 2013 Accepting new patients
The Board of Trustees of the University of Illinois CurrentSince Jun 3, 2013 Accepting new patients

Locations

7694 Solutions Ctr
Chicago, IL 60677

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

507 E Armstrong Ave
Peoria, IL 61603
Phone (309) 681-6960

1 Illini Dr
Peoria, IL 61605
Phone (309) 671-3000

1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195

2806 N Knoxville Ave
Peoria, IL 61604
Phone (309) 655-6961

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1370563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370563200000",
    "number": "1396183786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 E ARMSTRONG AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616033201",
            "telephone_number": "309-681-6960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "507 E ARMSTRONG AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616033201",
            "telephone_number": "309-681-6960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZIMMERMAN",
        "first_name": "AMY",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-07",
        "last_updated": "2013-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SP0200X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Pediatrics",
            "state": "IL",
            "license": "209009987",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "376000511",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.