Individual provider Active NPI

Lauren Aileen Bunner, CPNP-PC

  • Pediatric Nurse Practitioner
  • Springfield, IL
National Provider Identifier
1396365102
Registry record updated Sep 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
209025098 Issued in IL
Practice address
415 N 9TH St # 4W16
Springfield, IL 62702-5303
Phone
(217) 545-8000
NPI assigned
Apr 22, 2020
Last updated
Sep 1, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 1, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 209025098 IL Primary
Registered Nurse 163W00000X 041429321 IL

Addresses

Primary practice location

415 N 9TH St # 4W16
Springfield, IL 62702-5303

Mailing address

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

Other practice location 1

800 E Carpenter St
Springfield, IL 62769-1000
Phone (217) 473-5802

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
I20220920003531 IL Practitioner - Nurse Practitioner 9638554058 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
041429321ILMDRegistered Nurse
209025098ILMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Siu Physicians & Surgeons, Inc CurrentSince Oct 17, 2022 Accepting new patients
Siu Physicians & Surgeons, Inc CurrentSince Oct 17, 2022 Accepting new patients
Siu Physicians & Surgeons, Inc Past Accepting new patients

Locations

201 E Madison St
Ste 328
Springfield, IL 62702

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

415 N 9th St
Springfield, IL 62702
Phone (217) 545-5117

415 N 9th St
#4W16
Springfield, IL 62702
Phone (800) 331-2229

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.

NPI Registry JSON

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

{
    "created_epoch": "1587513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661990400000",
    "number": "1396365102",
    "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": "415 N 9TH ST # 4W16",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627025303",
            "telephone_number": "217-545-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 E Carpenter St",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "IL",
            "postal_code": "627691000",
            "country_code": "US",
            "telephone_number": "217-473-5802",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUNNER",
        "first_name": "LAUREN",
        "middle_name": "AILEEN",
        "credential": "CPNP-PC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-04-22",
        "last_updated": "2022-09-01",
        "certification_date": "2022-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IL",
            "license": "209025098",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041429321",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.