Individual provider Active NPI

Heather Rae Stroo, FNP-BC

  • Family Nurse Practitioner
  • Kankakee, IL
National Provider Identifier
1477925238
Registry record updated Dec 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209.013750 Issued in IL
Practice address
375 N Wall St Ste P630
Kankakee, IL 60901-3495
Phone
(815) 937-2122
Fax
(815) 937-2102
NPI assigned
Oct 20, 2015
Last updated
Dec 6, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2021

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 209.013750 IL Primary

Addresses

Primary practice location

375 N Wall St Ste P630
Kankakee, IL 60901-3495

Mailing address

375 N Wall St Ste P630
Kankakee, IL 60901-3495
Phone (815) 937-2122

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
I20161219000196 IL Practitioner - Nurse Practitioner 3870873441 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209.013750ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Joseph B. Pigato, LTD CurrentSince Nov 5, 2016 Accepting new patients
Bonaventure Medical Foundation, LLC Past Accepting new patients

Locations

375 N Wall St
Ste P630
Kankakee, IL 60901
Phone (815) 933-4510

455 W Court St
Ste 201
Kankakee, IL 60901
Phone (815) 937-2122

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1445299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638748800000",
    "number": "1477925238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 N WALL ST STE P630",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609013495",
            "telephone_number": "815-937-2122",
            "fax_number": "815-937-2102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 N WALL ST STE P630",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609013495",
            "telephone_number": "815-937-2122",
            "fax_number": "815-937-2102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STROO",
        "first_name": "HEATHER",
        "middle_name": "RAE",
        "name_prefix": "Ms.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-20",
        "last_updated": "2021-12-06",
        "certification_date": "2021-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.013750",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kankakee, IL

Sources for this page

Verify at the official NPI Registry.