Individual provider Active NPI

Kayla B Wuebbels, FNP

  • Family Nurse Practitioner
  • Maryville, IL
National Provider Identifier
1417474511
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209016393 Issued in IL
Practice address
20 Professional Park Dr Ste B
Maryville, IL 62062-5830
Phone
(618) 288-1480
Fax
(618) 288-2407
NPI assigned
Aug 29, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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 209016393 IL Primary

Addresses

Primary practice location

20 Professional Park Dr Ste B
Maryville, IL 62062-5830

Mailing address

20 Professional Park Dr Ste B
Maryville, IL 62062-5830
Phone (618) 288-1480

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
I20171018003384 IL Practitioner - Nurse Practitioner 3375819386 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anderson Medical Group LLCGroup PAC ID 5193792018, 136 clinicians

Practice addresses (Care Compare)

20 Professional Park Dr
Suite B
Maryville, IL 62062-5830
Phone (618) 288-1480

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
74.76 of 100Reported as group
Quality
54.98
Promoting interoperability
85
Improvement activities
40
Cost
73.39

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Anderson Medical Group, LLC CurrentSince Sep 18, 2017 Accepting new patients
Granite City Clinic Corp PastSince Sep 18, 2017 Accepting new patients

Locations

6810 State Route 162
Ste 215
Maryville, IL 62062
Phone (618) 391-6405

20 Professional Park Dr
Ste B
Maryville, IL 62062
Phone (618) 205-3655

Organizations & group practices 2

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.

Hospital & facility affiliations 1

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": "1503964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1417474511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 PROFESSIONAL PARK DR STE B",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620625830",
            "telephone_number": "618-288-1480",
            "fax_number": "618-288-2407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 PROFESSIONAL PARK DR STE B",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620625830",
            "telephone_number": "618-288-1480",
            "fax_number": "618-288-2407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WUEBBELS",
        "first_name": "KAYLA",
        "middle_name": "B",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-29",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209016393",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maryville, IL

Sources for this page

Verify at the official NPI Registry.