Individual provider Active NPI

Jill Ann Stoops, FNP-BC

  • Family Nurse Practitioner
  • Springfield, IL
National Provider Identifier
1407908015
Registry record updated Jan 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209-001105 Issued in IL
Practice address
2833 S Grand Ave E Ste 100
Springfield, IL 62703-2175
Phone
(217) 789-2069
Fax
(217) 535-3104
NPI assigned
Jan 17, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 29, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 209.001105 IL
Family Nurse Practitioner 363LF0000X 209-001105 IL Primary

Addresses

Primary practice location

2833 S Grand Ave E Ste 100
Springfield, IL 62703-2175

Mailing address

PO Box 19639
Springfield, IL 62794-9639
Phone (217) 545-8000

Other practice location 1

520 N 4th St
Springfield, IL 62702-5238
Phone (217) 545-8000

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
I20130920000169 IL Practitioner - Nurse Practitioner 1052555695 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209.001105ILMDNurse Practitioner
209-001105ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Board of Trustees of Southern Illinois University CurrentSince Oct 1, 2019 Accepting new patients
Board of Trustees of Southern Illinois University Current Accepting new patients
Board of Trustees of Southern Illinois University CurrentSince Oct 1, 2019 Accepting new patients

Locations

2833 South Grand Ave E
Springfield, IL 62703
Phone (217) 535-3100

2833 South Grand Ave E
#100
Springfield, IL 62703
Phone (217) 535-3100

520 N 4th St
Springfield, IL 62702
Phone (217) 757-8100

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706486400000",
    "number": "1407908015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19639",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627949639",
            "telephone_number": "217-545-8000",
            "fax_number": "844-470-2486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2833 S GRAND AVE E STE 100",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627032175",
            "telephone_number": "217-789-2069",
            "fax_number": "217-535-3104"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "520 N 4th St",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "IL",
            "postal_code": "627025238",
            "country_code": "US",
            "telephone_number": "217-545-8000",
            "fax_number": "217-757-8161",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STOOPS",
        "first_name": "JILL",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-17",
        "last_updated": "2024-01-29",
        "certification_date": "2024-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209.001105",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209-001105",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.