Individual provider Active NPI

Jessica Lynn Walker, FNP-BC

  • Family Nurse Practitioner
  • Collinsville, IL
National Provider Identifier
1639476369
Registry record updated Aug 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209-008649 Issued in IL
Practice address
531 Vandalia St
Collinsville, IL 62234-4061
Phone
(618) 344-0090
Fax
(618) 344-4371
NPI assigned
Feb 15, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2024

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 209-008649 IL Primary

Addresses

Primary practice location

531 Vandalia St
Collinsville, IL 62234-4061

Mailing address

6810 State Route 162
Box 215
Maryville, IL 62062
Phone (618) 391-6495

Other practice location 1

1285 Franciscan Dr
Litchfield, IL 62056-1778
Phone (217) 324-6127 ext. 200

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
I20140326000663 IL Practitioner - Nurse Practitioner 1759512213 Reassigns benefits to 2 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
Anderson Medical Group LLCGroup PAC ID 5193792018, 136 clinicians

Practice addresses (Care Compare)

1103 Belt Line Rd
Collinsville, IL 62234-4368
Phone (618) 344-2273

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
74.76 of 100Reported as group
Quality
54.98
Promoting interoperability
85
Improvement activities
40
Cost
73.39

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209-008649ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Anderson Medical Group, LLC CurrentSince Mar 1, 2023 Accepting new patients
Litchfield Family Practice Center CurrentSince Feb 15, 2011 Accepting new patients

Locations

1103 Belt Line Rd
#B
Collinsville, IL 62234
Phone (618) 344-0090

531 Vandalia St
Collinsville, IL 62234
Phone (618) 344-0090

1285 Franciscan Dr
Litchfield, IL 62056
Phone (217) 324-1035

6810 State Route 162
Ste 215
Maryville, IL 62062
Phone (618) 391-6405

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, 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": "1297728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724803200000",
    "number": "1639476369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6810 STATE ROUTE 162",
            "address_2": "BOX 215",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "62062",
            "telephone_number": "618-391-6495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "531 VANDALIA ST",
            "city": "COLLINSVILLE",
            "state": "IL",
            "postal_code": "622344061",
            "telephone_number": "618-344-0090",
            "fax_number": "618-344-4371"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1285 Franciscan Dr",
            "address_purpose": "LOCATION",
            "city": "Litchfield",
            "state": "IL",
            "postal_code": "620561778",
            "country_code": "US",
            "telephone_number": "217-324-6127 x200",
            "fax_number": "217-324-5959",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALKER",
        "first_name": "JESSICA",
        "middle_name": "LYNN",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-02-15",
        "last_updated": "2024-08-28",
        "certification_date": "2024-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209-008649",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Collinsville, IL

Sources for this page

Verify at the official NPI Registry.