Individual provider Active NPI

Maddison Rae Maxedon, APRN

  • Nurse Practitioner
  • Mt Zion, IL
National Provider Identifier
1629862982
Registry record updated Apr 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209.032157 Issued in IL
Practice address
104 E Ashland Ave
Mt Zion, IL 62549-1271
Phone
(217) 864-2665
NPI assigned
Apr 9, 2025
Last updated
Apr 9, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2025

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 209.032157 IL Primary

Addresses

Primary practice location

104 E Ashland Ave
Mt Zion, IL 62549-1271

Mailing address

104 E Ashland Ave
Mt Zion, IL 62549-1271

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
I20250815001342 IL Practitioner - Nurse Practitioner 6305345521 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Decatur Orthopedic Center LLCGroup PAC ID 4981844289, 9 clinicians

Practice addresses (Care Compare)

104 E Ashland Ave
Mt Zion, IL 62549-1271
Phone (217) 864-2665

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209.032157ILMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Decatur Orthopedic Center, LLC CurrentSince Oct 21, 2025 Accepting new patients
Kirby Medical Center CurrentSince Jun 25, 2025 Accepting new patients
Kirby Medical Center CurrentSince Jun 25, 2025 Accepting new patients
Kirby Medical Center Past Accepting new patients

Locations

1000 Medical Center Dr
Monticello, IL 61856
Phone (217) 762-1540

1000 Medical Center Dr
Ste A
Monticello, IL 61856

104 E Ashland Ave
Mt Zion, IL 62549
Phone (217) 864-2665

Organizations & group practices 4

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": "1744156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744156800000",
    "number": "1629862982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 E ASHLAND AVE",
            "city": "MT ZION",
            "state": "IL",
            "postal_code": "625491271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 E ASHLAND AVE",
            "city": "MT ZION",
            "state": "IL",
            "postal_code": "625491271",
            "telephone_number": "217-864-2665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAXEDON",
        "first_name": "MADDISON",
        "middle_name": "RAE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-04-09",
        "last_updated": "2025-04-09",
        "certification_date": "2025-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209.032157",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mt Zion, IL

Sources for this page

Verify at the official NPI Registry.