Jessica Lyons, NP
Individual provider Active NPI Family Nurse Practitioner · Odin, IL
NPI 1477337293 · NPPES record last updated Apr 9, 2024
Key facts
- NPI
- 1477337293
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 209019673 (IL)
- Practice address
- 3283 Farthing Rd
Odin, IL 62870-2035 - Phone
- (618) 780-1680
- NPI assigned
- Aug 22, 2023
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240610003535 | IL | Practitioner - Nurse Practitioner | 3577005297 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science - Nursing, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209019673 | IL | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gerio Primary Care PC | Current |
Accepting new patients | |
| Gerio Primary Care | Past |
Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/FEEBDD
- jbuntingmalhotra17889@direct.hfhs.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 209019673 | IL | Yes |
Addresses
Primary practice location
3283 Farthing Rd
Odin, IL 62870-2035
Mailing address
3283 Farthing Rd
Odin, IL 62870-2035
Phone (618) 780-1680
Other providers in Odin, IL
- Kaylee Beth Heinzmann
- Marion County Ambulance Service Inc.
- Odin Grade SCH 122
- Odin Health and Rehab Center LLC
- Odin Health and Rehab Center LLC
- Odin Health and Rehab Center LLC
All providers in Odin, IL · Family Nurse Practitioner in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 9, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.