NPIMap

Individual provider Active NPI

Kelli Marie Vaughn, FNP-BC

  • Family Nurse Practitioner
  • Paxton, IL
National Provider Identifier
1477800175
Registry record updated Sep 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209009705 Issued in IL
Practice address
227 N Market St
Paxton, IL 60957-1123
Phone
(217) 379-4864
NPI assigned
Aug 13, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2020

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 209009705 IL Primary

Addresses

Primary practice location

227 N Market St
Paxton, IL 60957-1123

Mailing address

1120 N Melvin St
Gibson City, IL 60936-1477
Phone (217) 379-4864

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kelli.vaughm.p5@direct.gapho.nextgenshare.com Direct

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
I20121016000289 IL Practitioner - Nurse Practitioner 0042460719 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

227 N Market St
Paxton, IL 60957-1123
Phone (217) 379-4864

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Gibson Community Hospital Association Current Accepting new patients
Gibson Community Hospital Association CurrentSince Aug 7, 2012 Accepting new patients
Gibson Community Hospital Association CurrentSince Aug 7, 2012 Accepting new patients

Locations

7 Doctors Park
Gibson City, IL 60936
Phone (217) 784-5500

1120 N Melvin St
Gibson City, IL 60936
Phone (217) 355-1684

227 N Market St
Paxton, IL 60957
Phone (217) 379-4864

Interoperability endpoints

  • Direct secure messaging: kelli.vaughn.p5@direct.gapho.nextgenshare.com

Organizations & group practices 3

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 23

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 23

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1344816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600732800000",
    "number": "1477800175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 N MELVIN ST",
            "city": "GIBSON CITY",
            "state": "IL",
            "postal_code": "609361477",
            "telephone_number": "217-379-4864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "227 N MARKET ST",
            "city": "PAXTON",
            "state": "IL",
            "postal_code": "609571123",
            "telephone_number": "217-379-4864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAUGHN",
        "first_name": "KELLI",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-13",
        "last_updated": "2020-09-22",
        "certification_date": "2020-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209009705",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kelli.vaughm.p5@direct.gapho.nextgenshare.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "227 N Market St",
            "city": "Paxton",
            "state": "IL",
            "country_code": "US",
            "postal_code": "609571123",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Paxton, IL

Sources for this page

Verify at the official NPI Registry.