NPIMap

Organization Active NPI

Two Roads Wellness Clinic, LLC

Doing business as Two Roads Wellness Clinic

  • Primary Care Nurse Practitioner
  • Danville, IL
National Provider Identifier
1417329426
Registry record updated May 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
Legal business name
TWO ROADS WELLNESS CLINIC, LLC
Doing business as
Two Roads Wellness Clinic
Practice address
3545 N Vermilion St
Danville, IL 61832-1100
Phone
(217) 651-6801
Fax
(217) 651-6802
NPI assigned
Oct 29, 2015
Last updated
May 14, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2026

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

Authorized official

Name
Mrs. Jessica Nemecz, LCPCNPI 1407977135
Title
Counselor
Phone
(217) 651-6801

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X NU
Nurse Practitioner 363L00000X NU
Primary Care Nurse Practitioner 363LP2300X NU Primary
Counselor 101Y00000X NU
Community/Behavioral Health Agency 251S00000X NU

Addresses

Primary practice location

3545 N Vermilion St
Danville, IL 61832-1100

Mailing address

3545 N Vermilion St
Danville, IL 61832-1100
Phone (217) 651-6801

Other practice location 1

1002 Churchill Rd Ste 1
Mahomet, IL 61853-7456
Phone (217) 655-4993

Other practice location 2

3115 Village Office Pl
Champaign, IL 61822-7673
Phone (217) 531-4101

Other names 1

  • Two Roads Wellness Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230613003222 IL Part B Supplier - Clinic/Group Practice 9638536220 Receives reassigned benefits from 11 practitioners
Practice locations: Danville, IL

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D2187374Two Roads Wellness Clinic3545 N Vermilion, Danville, IL 61832Certificate of waiverMay 3, 2027
14D2187667Two Roads Wellness Clinic3115 Village Office Place, Champaign, IL 61822Certificate of waiverJan 19, 2028

National Provider Directory

National Provider Directory
Tax ID family
Two Roads Wellness Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1101 E Winter Ave
Danville, IL 61832
Phone (217) 651-6801

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1446076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778716800000",
    "number": "1417329426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3545 N VERMILION ST",
            "city": "DANVILLE",
            "state": "IL",
            "postal_code": "618321100",
            "telephone_number": "217-651-6801",
            "fax_number": "217-651-6802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3545 N VERMILION ST",
            "city": "DANVILLE",
            "state": "IL",
            "postal_code": "618321100",
            "telephone_number": "217-651-6801",
            "fax_number": "217-651-6802"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1002 Churchill Rd Ste 1",
            "address_purpose": "LOCATION",
            "city": "Mahomet",
            "state": "IL",
            "postal_code": "618537456",
            "country_code": "US",
            "telephone_number": "217-655-4993",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3115 Village Office Pl",
            "address_purpose": "LOCATION",
            "city": "Champaign",
            "state": "IL",
            "postal_code": "618227673",
            "country_code": "US",
            "telephone_number": "217-531-4101",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TWO ROADS WELLNESS CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-29",
        "last_updated": "2026-05-14",
        "certification_date": "2026-05-14",
        "status": "A",
        "authorized_official_last_name": "NEMECZ",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "COUNSELOR",
        "authorized_official_telephone_number": "217-651-6801",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Two Roads Wellness Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Danville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.