Individual provider Active NPI

Sandra A Fader, APN

  • Nurse Practitioner
  • Bloomington, IL
National Provider Identifier
1467961706
Registry record updated Jan 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209016547 Issued in IL
Practice address
1111 Trinity LN Ste 111
Bloomington, IL 61704-8112
Phone
(309) 663-6461
Fax
(309) 663-5711
NPI assigned
Sep 28, 2017
Last updated
Jan 29, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2025

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 209016547 IL Primary
Family Nurse Practitioner 363LF0000X 209016547 IL

Addresses

Primary practice location

1111 Trinity LN Ste 111
Bloomington, IL 61704-8112

Mailing address

611 W. Park St
Fapc
Urbana, IL 61801

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
I20171106000280 IL Practitioner - Nurse Practitioner 5294091450 Reassigns benefits to 4 organizations

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
Carle Health Care IncorporatedGroup PAC ID 3577515774, 1,592 clinicians
Methodist Medical Center of IllinoisGroup PAC ID 1355259714, shared by 8 NPIs, 387 clinicians

Practice addresses (Care Compare)

3591 Griffin Ave
Pekin, IL 61554-6258

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

900 Main St
Suite 100
Peoria, IL 61602-5003
Phone (309) 672-4202

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Carle Health Medical Group CurrentSince Oct 14, 2024 Accepting new patients
Methodist Medical Center of Illinois Nurse Practitioner CurrentSince Oct 1, 2024 Accepting new patients
Methodist Medical Center of Illinois CurrentSince Oct 15, 2024 Accepting new patients
Carle West Physician Group Inc CurrentSince Aug 30, 2021 Accepting new patients
Methodist Medical Center of Illinois Current Accepting new patients
Carle Health Care Incorporated Past Accepting new patients

Locations

1111 Trinity Ln
Ste 111
Bloomington, IL 61704
Phone (309) 663-6461

2204 Eastland Dr
Bloomington, IL 61704
Phone (309) 662-9461

112 NE Crescent Ave
Peoria, IL 61606
Phone (309) 671-7779

815 Main St
Ste A
Peoria, IL 61602
Phone (309) 671-3000

900 Main St
Ste 100
Peoria, IL 61602
Phone (309) 671-7772

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

Interoperability endpoints

  • Direct secure messaging: sfaderaprn345731@carlehiedirect.net

Organizations & group practices 6

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": "1506556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738108800000",
    "number": "1467961706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W. PARK ST",
            "address_2": "FAPC",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "61801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 TRINITY LN STE 111",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617048112",
            "telephone_number": "309-663-6461",
            "fax_number": "309-663-5711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FADER",
        "first_name": "SANDRA",
        "middle_name": "A",
        "name_prefix": "Mrs.",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-28",
        "last_updated": "2025-01-29",
        "certification_date": "2025-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209016547",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209016547",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IL

Sources for this page

Verify at the official NPI Registry.