Individual provider Active NPI

Kristene Mychelle Flanagan, APRN

  • Family Nurse Practitioner
  • Peoria, IL
National Provider Identifier
1629644836
Registry record updated Dec 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209.022864 Issued in IL
Practice address
1001 Main St Ste 500a
Peoria, IL 61606-2038
Phone
(309) 672-4980
NPI assigned
May 28, 2021
Last updated
Dec 14, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 14, 2023

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 209.022864 IL Primary

Addresses

Primary practice location

1001 Main St Ste 500a
Peoria, IL 61606-2038

Mailing address

1001 Main St Ste 500a
Peoria, IL 61606-2038
Phone (309) 696-9279

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
I20220507000179 IL Practitioner - Nurse Practitioner 9537546890 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

5105 N Glen Park Place Rd
Peoria, IL 61614-4688
Phone (309) 308-5900

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.21 of 100Reported as group
Quality
67.65
Promoting interoperability
99
Improvement activities
40
Cost
80.55

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209.022864ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Methodist Medical Center of Illinois Family CurrentSince Mar 1, 2024 Accepting new patients
Methodist Medical Center of Illinois CurrentSince Mar 1, 2024 Accepting new patients
Illinois Gastroenterology Group, LLC CurrentSince Mar 1, 2023 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Michael D. Tarantino, M.D. S.C. CurrentSince Apr 25, 2022 Accepting new patients
Northwest Gastroenterologists SC Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Jan 9, 2025 Accepting new patients
Elgin Gastroenterology SC Current Accepting new patients
Methodist Medical Center of Illinois Current Accepting new patients
Elgin Gastroenterology Endoscopy Center LLC Current Accepting new patients

Locations

745 Fletcher Dr
Ste 202
Elgin, IL 60123
Phone (855) 483-7362

2550 W Algonquin Rd
Lk in the Hls, IL 60156
Phone (847) 458-1246

1001 Main St
Ste 500A
Peoria, IL 61606
Phone (309) 672-4980

112 NE Crescent Ave
Peoria, IL 61606
Phone (309) 696-9857

1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195

427 W Northmoor Rd
Peoria, IL 61614
Phone (309) 692-5337

5105 N Glen Park Place Rd
Peoria, IL 61614
Phone (309) 308-5900

815 Main St
Ste A
Peoria, IL 61602
Phone (309) 671-3000

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

Organizations & group practices 10

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 1

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": "1622160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702512000000",
    "number": "1629644836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 MAIN ST STE 500A",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616062038",
            "telephone_number": "309-696-9279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 MAIN ST STE 500A",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616062038",
            "telephone_number": "309-672-4980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLANAGAN",
        "first_name": "KRISTENE",
        "middle_name": "MYCHELLE",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-05-28",
        "last_updated": "2023-12-14",
        "certification_date": "2023-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.022864",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.