NPIMap

Individual provider Active NPI

Jennifer Brooke Jensen, FNP

  • Nurse Practitioner
  • Roanoke, IL
National Provider Identifier
1447923172
Registry record updated Jul 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209023220 Issued in IL
Practice address
401 N Main St
Roanoke, IL 61561-7585
Phone
(309) 923-2661
NPI assigned
Jul 28, 2021
Last updated
Jul 28, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 28, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 209023220 IL Primary

Addresses

Primary practice location

401 N Main St
Roanoke, IL 61561-7585

Mailing address

1057 50TH St
Roseville, IL 61473-9218
Phone (309) 224-0214

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
I20211006001695 IL Practitioner - Nurse Practitioner 8426456484 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Osf Healthcare SystemGroup PAC ID 4284541806, 94 clinicians

Practice addresses (Care Compare)

1000 W Harlem Ave
Monmouth, IL 61462-1007
Phone (309) 734-3141

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
St Mary Medical Center CurrentSince Dec 1, 2022 Accepting new patients
St Mary Medical Center Nurse Practitioner CurrentSince Dec 1, 2022 Accepting new patients
Osf Healthcare System CurrentSince Oct 1, 2021 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Healthcare System CurrentSince Oct 1, 2021 Accepting new patients
Osf Multi-Specialty Group CurrentSince Oct 1, 2021 Accepting new patients
St Mary Medical Center Current Accepting new patients
Osf Healthcare System Past Accepting new patients
St Mary Medical Center Past Accepting new patients

Locations

100 N Monroe St
Abingdon, IL 61410
Phone (309) 462-2342

1000 W Harlem Ave
Monmouth, IL 61462
Phone (309) 734-1414

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

235 E Penn Ave
Roseville, IL 61473
Phone (309) 426-2128

Organizations & group practices 9

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 4

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": "1627430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627430400000",
    "number": "1447923172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1057 50TH ST",
            "city": "ROSEVILLE",
            "state": "IL",
            "postal_code": "614739218",
            "telephone_number": "309-224-0214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 N MAIN ST",
            "city": "ROANOKE",
            "state": "IL",
            "postal_code": "615617585",
            "telephone_number": "309-923-2661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENSEN",
        "first_name": "JENNIFER",
        "middle_name": "BROOKE",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-28",
        "last_updated": "2021-07-28",
        "certification_date": "2021-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209023220",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, IL

Sources for this page

Verify at the official NPI Registry.