NPIMap

Individual provider Active NPI

Jonathan Rider, N.P.

  • Gerontology Nurse Practitioner
  • Pekin, IL
National Provider Identifier
1437526852
Registry record updated Oct 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
209013212 Issued in IL
Practice address
600 S 13TH St
Suite E
Pekin, IL 61554-4936
Phone
(309) 353-9709
Fax
(309) 353-0929
NPI assigned
Sep 2, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 209013212 IL Primary

Addresses

Primary practice location

600 S 13TH St
Suite E
Pekin, IL 61554-4936

Mailing address

600 S 13TH St
Suite E
Pekin, IL 61554-4936
Phone (309) 353-9709

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151001002353 IL Practitioner - Nurse Practitioner 0648588186 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Methodist Medical Center of IllinoisGroup PAC ID 1355259714, shared by 8 NPIs, 387 clinicians
Proctor Health SystemsGroup PAC ID 3476440173, 131 clinicians
Carle Health Care IncorporatedGroup PAC ID 3577515774, 1,592 clinicians

Practice addresses (Care Compare)

2338 W Van Winkle Way
3300 Family Medicine North
Peoria, IL 61615-7485
Phone (309) 693-2020

5401 N Knoxville Ave
Peoria, IL 61614-5021

611 W Park St
Urbana, IL 61801-2501
Phone (888) 712-2753

815 Main St
Suite a
Peoria, IL 61602-1080
Phone (309) 672-4977

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209013212ILMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Methodist Medical Center of Illinois CurrentSince Jul 1, 2025 Accepting new patients
Proctor Health Systems CurrentSince Mar 1, 2023 Accepting new patients
Pekin Prohealth Inc CurrentSince Oct 3, 2016 Accepting new patients
Proctor Health Systems Current Accepting new patients
Methodist Medical Center of Illinois Current Accepting new patients
Methodist Medical Center of Illinois Gerontology CurrentSince Jul 1, 2025 Accepting new patients
Proctor Health Systems CurrentSince Mar 1, 2023 Accepting new patients
Carle Health Care Incorporated CurrentSince Jan 1, 2026 Accepting new patients

Locations

600 S 13th St
Ste E
Pekin, IL 61554
Phone (309) 353-0473

600 S 13th St
Pekin, IL 61554
Phone (309) 347-1151

112 NE Crescent Ave
Peoria, IL 61606
Phone (309) 680-2402

5401 N Knoxville Ave
Ste 400
Peoria, IL 61614
Phone (309) 691-6610

2338 W Van Winkle Way
Ste 3300
Peoria, IL 61615
Phone (309) 693-2020

221 NE Glen Oak Ave
#100
Peoria, IL 61636

815 Main St
Ste A
Peoria, IL 61602
Phone (309) 672-4986

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

Interoperability endpoints

  • Direct secure messaging: jrideraprn388579@carlehiedirect.net

Organizations & group practices 8

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 5

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": "1441152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477353600000",
    "number": "1437526852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 S 13TH ST",
            "address_2": "SUITE E",
            "city": "PEKIN",
            "state": "IL",
            "postal_code": "615544936",
            "telephone_number": "309-353-9709",
            "fax_number": "309-353-0929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 S 13TH ST",
            "address_2": "SUITE E",
            "city": "PEKIN",
            "state": "IL",
            "postal_code": "615544936",
            "telephone_number": "309-353-9709",
            "fax_number": "309-353-0929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIDER",
        "first_name": "JONATHAN",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-09-02",
        "last_updated": "2016-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IL",
            "license": "209013212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pekin, IL

Sources for this page

Verify at the official NPI Registry.