Individual provider Active NPI

Amy Lynn Smith, APN

  • Nurse Practitioner
  • Peru, IL
National Provider Identifier
1619435252
Registry record updated Mar 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209.018888 Issued in IL
Practice address
925 West St
Peru, IL 61354-2757
Phone
(815) 223-3300
NPI assigned
Mar 2, 2019
Last updated
Mar 2, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 209.018888 IL Primary

Addresses

Primary practice location

925 West St
Peru, IL 61354-2757

Mailing address

28 N 42ND Rd
Mendota, IL 61342-9653
Phone (815) 228-1351

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
I20190627002711 IL Practitioner - Nurse Practitioner 8224362017 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
24 On Physicians PCGroup PAC ID 5698688141, 274 clinicians
Osf Healthcare SystemGroup PAC ID 4284541806, 94 clinicians

Practice addresses (Care Compare)

1100 E Norris Dr
Ottawa, IL 61350-1604
Phone (815) 431-5380

535 Park Ave E
Princeton, IL 61356-2537
Phone (815) 875-4531

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209.018888ILMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
24 On Physicians, PC CurrentSince Sep 1, 2025 Accepting new patients
Osf Healthcare System CurrentSince Jun 25, 2023 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Healthcare System Current Accepting new patients
24 On Physicians, P.C. CurrentSince Sep 1, 2025 Accepting new patients
Osf Multi-Specialty Group CurrentSince Jul 26, 2023 Accepting new patients
Osf Healthcare System CurrentSince Jun 25, 2023 Accepting new patients

Locations

1000 W Harlem Ave
Monmouth, IL 61462
Phone (309) 734-1414

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

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

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

925 West St
Peru, IL 61354
Phone (815) 223-3300

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

535 Park Ave E
Princeton, IL 61356
Phone (815) 875-4531

600 E 1st St
Spring Valley, IL 61362
Phone (815) 664-1477

Organizations & group practices 7

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 2

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": "1551484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551484800000",
    "number": "1619435252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 N 42ND RD",
            "city": "MENDOTA",
            "state": "IL",
            "postal_code": "613429653",
            "telephone_number": "815-228-1351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 WEST ST",
            "city": "PERU",
            "state": "IL",
            "postal_code": "613542757",
            "telephone_number": "815-223-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "AMY",
        "middle_name": "LYNN",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-02",
        "last_updated": "2019-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209.018888",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peru, IL

Sources for this page

Verify at the official NPI Registry.