NPIMap

Individual provider Active NPI

Alisha Jackson, FNP

  • Family Nurse Practitioner
  • Peru, IL
National Provider Identifier
1487197745
Registry record updated Nov 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209.015095 Issued in IL
Practice address
1650 Midtown Rd
Peru, IL 61354-1200
Phone
(815) 220-2645
NPI assigned
Nov 18, 2016
Last updated
Nov 18, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2016

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 209.015095 IL Primary

Addresses

Primary practice location

1650 Midtown Rd
Peru, IL 61354-1200

Mailing address

235 Poundstone Ave
PO Box 42
Grand Ridge, IL 61325-9100
Phone (815) 236-0024

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
I20181022002454 IL Practitioner - Nurse Practitioner 2567715519 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Saint James HospitalGroup PAC ID 0648187252, 74 clinicians

Practice addresses (Care Compare)

1100 E Norris Dr
Ottawa, IL 61350-1604
Phone (815) 433-3100

111 Spring St
FL 4
Streator, IL 61364-3332
Phone (815) 672-4587

1614 E Norris Dr
Osf Healthcare Medical Group Ottawa
Ottawa, IL 61350-3681
Phone (815) 433-1010

1640 1St Ave
Ottawa, IL 61350-9214
Phone (815) 431-9208

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209.015095ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Saint James Hospital CurrentSince Nov 12, 2023 Accepting new patients
Mendota Community Hospital CurrentSince Dec 12, 2023 Accepting new patients
Ottawa Regional Hospital & Healthcare Center CurrentSince Dec 1, 2022 Accepting new patients
Mendota Community Hospital Current Accepting new patients
Ottawa Regional Hospital & Healthcare Center CurrentSince Dec 1, 2022 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Saint James Hospital CurrentSince Nov 12, 2023 Accepting new patients
Osf Multi-Specialty Group CurrentSince Sep 10, 2018 Accepting new patients
Mendota Community Hospital CurrentSince Dec 12, 2023 Accepting new patients
Mendota Community Hospital Past Accepting new patients
Saint James Hospital Past Accepting new patients
Ottawa Regional Hospital & Healthcare Center Past Accepting new patients

Locations

327 Edward St
Henry, IL 61537
Phone (309) 364-2002

1051 W South St
Kewanee, IL 61443
Phone (309) 734-3141

1404 Washington St
Mendota, IL 61342
Phone (815) 538-1825

1100 E Norris Dr
Ottawa, IL 61350
Phone (815) 416-1224

1614 E Norris Dr
Ottawa, IL 61350
Phone (815) 433-1010

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

1650 Midtown Rd
Peru, IL 61354
Phone (815) 220-1122

530 Park Ave E
Princeton, IL 61356
Phone (815) 875-2811

111 Spring St
Fl 4
Streator, IL 61364
Phone (815) 672-4587

Organizations & group practices 12

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 3

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": "1479427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479427200000",
    "number": "1487197745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 POUNDSTONE AVE",
            "address_2": "PO BOX 42",
            "city": "GRAND RIDGE",
            "state": "IL",
            "postal_code": "613259100",
            "telephone_number": "815-236-0024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 MIDTOWN RD",
            "city": "PERU",
            "state": "IL",
            "postal_code": "613541200",
            "telephone_number": "815-220-2645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ALISHA",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-18",
        "last_updated": "2016-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.015095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peru, IL

Sources for this page

Verify at the official NPI Registry.