Courtney Brooke Elliott, RN, CPNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

209.012897 Issued in IL

Practice address

100 W 15TH St
Beardstown, IL 62618-1774

Phone

(217) 323-2245

Fax

(217) 323-2684

NPI assigned

Dec 18, 2013

Last updated

Jun 30, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Pediatric Nurse Practitioner, Nurse Practitioner, Registered Nurse

State licenses

Practice roles

Locations

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.

• Schuyler County Hospital District

  • Critical Access Hospital
  • Rushville, IL
  • NPI 1013969112
  Medicare reassignment NPD
• Schuyler County Hospital District

  dba Community Medical Clinic of Table Grove

  • Rural Health Clinic/Center
  • Table Grove, IL
  • NPI 1194223719
  NPD
• Schuyler County Hospital District

  dba Elmer Hugh Taylor Clinic

  • Rural Health Clinic/Center
  • Beardstown, IL
  • NPI 1235182874
  NPD (past)
• Schuyler County Hospital District

  dba Sarah D Culbertston Memorial Hospita

  • Medicare Defined Swing Bed Hospital Unit
  • Rushville, IL
  • NPI 1326093667
  NPD (past)

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

{
    "created_epoch": "1387324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435622400000",
    "number": "1487075305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 W 15TH ST",
            "city": "BEARDSTOWN",
            "state": "IL",
            "postal_code": "626181774",
            "telephone_number": "217-323-2245",
            "fax_number": "217-323-2684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 W 15TH ST",
            "city": "BEARDSTOWN",
            "state": "IL",
            "postal_code": "626181774",
            "telephone_number": "217-323-2245",
            "fax_number": "217-323-2684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIOTT",
        "first_name": "COURTNEY",
        "middle_name": "BROOKE",
        "credential": "RN, CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-12-18",
        "last_updated": "2015-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "TN",
            "license": "18596",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IL",
            "license": "209.012897",
            "primary": true
        },
        {
            "code": "163WP0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Pediatrics",
            "state": "TN",
            "license": "199590",
            "primary": false
        },
        {
            "code": "163WP0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Pediatrics",
            "state": "IL",
            "license": "041.430842",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Betty Jean Degroot, HOMEMAKER SUPERVISOR
• Dental Professionals of Illinois, P.C. (Beardstown Family Dental)
• Tamara Dodds, RN
• Carol June Easley
• Audra Jaye Elam, RSA
• Cynthia J Elliott, RSA
• Kadie Lee Ellner, BSW
• Michael David Elmore, BS
• Callie Jo Estes
• Evergreen Place Beardstown LLC (Evergreen Place)

• Pediatric Nurse Practitioner in Beardstown, IL
• Providers in Beardstown, IL by specialty
• Pediatric Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.