NPIMap

Individual provider Active NPI

Jessica N Baine, APRN

  • Family Nurse Practitioner
  • Carbondale, IL
National Provider Identifier
1548815293
Registry record updated Feb 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
029.019857 Issued in IL
Practice address
404 S Lewis LN
Carbondale, IL 62901
Phone
(618) 519-9200
Fax
(618) 549-1288
NPI assigned
Aug 8, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 029.019857 IL Primary
Registered Nurse 163W00000X 041441276 IL

Addresses

Primary practice location

404 S Lewis LN
Carbondale, IL 62901

Mailing address

PO Box 577
109 California St
Carterville, IL 62918-0577
Phone (618) 519-9200

Other names 1

  • Jessica N Stearns Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jessica.baine.1@14668.direct.athenahealth.com

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
I20190930003136 IL Practitioner - Nurse Practitioner 7719217017 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shawnee Health Service and Development Corp 51 clinicians

Practice addresses (Care Compare)

404 S Lewis LN
Carbondale, IL 62901-3547
Phone (618) 519-9200

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
041441276ILMDRegistered Nurse
029.019857ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Shawnee Health Service and Development Corp CurrentSince Sep 16, 2019 Accepting new patients
Shawnee Health Service and Development Corp CurrentSince Sep 16, 2019 Accepting new patients
Shawnee Health Service and Development Corp Current Accepting new patients
Shawnee Health Service and Development Corp Past Accepting new patients

Locations

404 S Lewis Ln
Carbondale, IL 62901
Phone (618) 319-4076

109 California St
Carterville, IL 62918
Phone (618) 985-8221

1006 S Division St
Carterville, IL 62918
Phone (618) 985-4841

Organizations & group practices 23

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.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1565222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675900800000",
    "number": "1548815293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 577",
            "address_2": "109 CALIFORNIA ST",
            "city": "CARTERVILLE",
            "state": "IL",
            "postal_code": "629180577",
            "telephone_number": "618-519-9200",
            "fax_number": "618-985-4635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 S LEWIS LN",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "62901",
            "telephone_number": "618-519-9200",
            "fax_number": "618-549-1288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAINE",
        "first_name": "JESSICA",
        "middle_name": "N",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-08",
        "last_updated": "2023-02-09",
        "certification_date": "2023-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "029.019857",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041441276",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jessica.baine.1@14668.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "404 S Lewis Ln",
            "city": "Carbondale",
            "state": "IL",
            "country_code": "US",
            "postal_code": "62901",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "STEARNS",
            "middle_name": "N",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Carbondale, IL

Sources for this page

Verify at the official NPI Registry.