Individual provider Active NPI

Elizabeth D. Deck, FNP-BC

  • Family Nurse Practitioner
  • Bourbonnais, IL
National Provider Identifier
1396715546
Registry record updated Oct 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209005074 Issued in IL
Practice address
400 Riverside Dr Ste 2100
Bourbonnais, IL 60914-5004
Phone
(815) 935-2784
Fax
(815) 935-5687
NPI assigned
Jan 23, 2006
Last updated
Oct 21, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209005074 IL Primary

Addresses

Primary practice location

400 Riverside Dr Ste 2100
Bourbonnais, IL 60914-5004

Mailing address

400 Riverside Dr Ste 2100
Bourbonnais, IL 60914-5004
Phone (815) 935-2784

Other identifiers 2

IdentifierTypeStateIssuer
DD8385OtherILRAILROAD MEDICARE
4632073OtherILBLUE CROSS

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
I20041015000431 IL Practitioner - Nurse Practitioner 5395705172 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Riverside Health SystemGroup PAC ID 3274434717, 202 clinicians

Practice addresses (Care Compare)

105 S 1St St
Willmington, IL 60481-8973
Phone (815) 476-5210

400 Riverside Dr
Suite 2800
Bourbonnais, IL 60914-5004
Phone (815) 935-1100

85 E Burns Rd
Bourbonnais, IL 60914-2193
Phone (815) 935-3332

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209005074ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Riverside Health System CurrentSince Apr 1, 2013 Accepting new patients
Riverside Health System Current Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

300 Riverside Dr
Ste 2100
Bourbonnais, IL 60914
Phone (815) 928-9666

300 Riverside Dr
Ste 2400
Bourbonnais, IL 60914
Phone (815) 935-2784

720 S Crescent St
Gilman, IL 60938
Phone (815) 265-4255

350 N Wall St
Kankakee, IL 60901
Phone (815) 935-7500

611 S Division St
Peotone, IL 60468
Phone (708) 258-9058

105 S First St
Wilmington, IL 60481
Phone (815) 476-5210

Interoperability endpoints

  • Direct secure messaging: edeck6938@direct.riversidehealthcare.net

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 3

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": "1137974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571616000000",
    "number": "1396715546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 RIVERSIDE DR STE 2100",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609145004",
            "telephone_number": "815-935-2784",
            "fax_number": "815-935-5687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 RIVERSIDE DR STE 2100",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609145004",
            "telephone_number": "815-935-2784",
            "fax_number": "815-935-5687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DECK",
        "first_name": "ELIZABETH",
        "middle_name": "D.",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-23",
        "last_updated": "2019-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209005074",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DD8385",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "4632073",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bourbonnais, IL

Sources for this page

Verify at the official NPI Registry.