NPIMap

Individual provider Active NPI

Jordan Peterson, APN

  • Family Nurse Practitioner
  • Galesburg, IL
National Provider Identifier
1518618123
Registry record updated Jan 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209.024644 Issued in IL
Practice address
3375 N Seminary St
Galesburg, IL 61401-1251
Phone
(309) 343-5114
NPI assigned
Jan 14, 2022
Last updated
Jan 20, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 20, 2022

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 209.024644 IL Primary

Addresses

Primary practice location

3375 N Seminary St
Galesburg, IL 61401-1251

Mailing address

3375 N Seminary St
Galesburg, IL 61401-1251
Phone (309) 343-5114

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
I20220210001463 IL Practitioner - Nurse Practitioner 6002209269 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osf Healthcare SystemGroup PAC ID 4284541806, 94 clinicians
Kewanee HospitalGroup PAC ID 4789578063, 26 clinicians
Advanced Physical Therapy Services, LTD.Group PAC ID 9133101462, shared by 5 NPIs, 216 clinicians

Practice addresses (Care Compare)

1051 W S St
Kewanee, IL 61443-8354
Phone (309) 852-7500

300 Tenney St
Kewanee, IL 61443-3452
Phone (309) 853-5500

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209.024644ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Osf Multi-Specialty Group CurrentSince Feb 3, 2022 Accepting new patients
St Mary Medical Center CurrentSince Dec 1, 2022 Accepting new patients
St Mary Medical Center CurrentSince Dec 1, 2022 Accepting new patients
Osf Healthcare System CurrentSince Dec 5, 2023 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Healthcare System Current Accepting new patients
Osf Healthcare System CurrentSince Dec 5, 2023 Accepting new patients
Osf Multi-Specialty Group CurrentSince Feb 3, 2022 Accepting new patients
St Mary Medical Center Current Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
Osf Healthcare System Past Accepting new patients

Locations

3315 N Seminary St
Galesburg, IL 61401
Phone (309) 344-1000

3315 N Seminary St
#101
Galesburg, IL 61401
Phone (309) 344-1000

3375 N Seminary St
Galesburg, IL 61401
Phone (309) 343-5114

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

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

Organizations & group practices 11

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": "1642118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642636800000",
    "number": "1518618123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3375 N SEMINARY ST",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614011251",
            "telephone_number": "309-343-5114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3375 N SEMINARY ST",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614011251",
            "telephone_number": "309-343-5114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JORDAN",
        "credential": "APN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-01-14",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.024644",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Galesburg, IL

Sources for this page

Verify at the official NPI Registry.