Active NPI
Teresa Blair, APN
- Family Nurse Practitioner
- Warren, IL
National Provider Identifier
1629051503
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 209005291
- Practice address
- 606 Tisdell Ave
Warren, IL 61087 - Phone
- (815) 745-2644
- Fax
- (815) 745-2546
- NPI assigned
- Nov 23, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 209005291 | IL | Primary |
Addresses
Primary practice location
606 Tisdell Ave
Warren, IL 61087
Mailing address
421 W Exchange St
PO Box 268
Freeport, IL 61032-4008
Phone (815) 599-7958
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 209005291 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Freeport Regional Health Care Foundation | Past | Accepting new patients | |
| Freeport Memorial Hospital | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Health Educator
- Freeport, IL
- NPI 1326880386
-
- Durable Medical Equipment & Medical Supplies
- Warren, IL
- NPI 1255471025
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132704000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1508284800000",
"number": "1629051503",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "421 W EXCHANGE ST",
"address_2": "PO BOX 268",
"city": "FREEPORT",
"state": "IL",
"postal_code": "610324008",
"telephone_number": "815-599-7958"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "606 TISDELL AVE",
"city": "WARREN",
"state": "IL",
"postal_code": "61087",
"telephone_number": "815-745-2644",
"fax_number": "815-745-2546"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLAIR",
"first_name": "TERESA",
"credential": "APN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-11-23",
"last_updated": "2017-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "IL",
"license": "209005291",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "209005291",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Warren, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.