Individual provider Active NPI

Marissa L Frost, APRN, CNP

  • Family Nurse Practitioner
  • Dixon, IL
National Provider Identifier
1639786270
Registry record updated Dec 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209.022022 Issued in IL
Practice address
102 S Hennepin Ave
Dixon, IL 61021-3013
Phone
(815) 288-7711
Fax
(815) 285-8903
NPI assigned
Sep 28, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 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 209.022022 IL Primary

Addresses

Primary practice location

102 S Hennepin Ave
Dixon, IL 61021-3013

Mailing address

102 S Hennepin Ave Ste 102
Dixon, IL 61021-3077
Phone (815) 288-7711

Other practice location 1

403 E 1st St
Dixon, IL 61021-3116
Phone (815) 288-5531

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
I20201120001356 IL Practitioner - Nurse Practitioner 6901217090 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

102 S Hennepin Ave
Suite 201
Dixon, IL 61021-3013
Phone (815) 288-7711

1840 1St Ave
Sterling, IL 61081-1202
Phone (779) 251-6100

8600 State Route 91
Suite 130
Peoria, IL 61615-7829
Phone (309) 683-5050

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.78 of 100Reported as group
Quality
60.49
Promoting interoperability
100
Improvement activities
40
Cost
77.11

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209.022022ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
KSB Medical Group, Inc. CurrentSince Nov 1, 2020 Accepting new patients
Osf Multi-Specialty Group CurrentSince Dec 11, 2024 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Katherine Shaw Bethea Hospital CurrentSince Nov 1, 2020 Accepting new patients
KSB Medical Group, Inc. CurrentSince Nov 1, 2020 Accepting new patients
Cardinal Medical Group, LTD. PastSince Dec 15, 2024 Accepting new patients

Locations

215 E 1st St
Ste 111
Dixon, IL 61021
Phone (815) 285-5477

403 E 1st St
Dixon, IL 61021
Phone (815) 285-5629

102 S Hennepin Ave
Dixon, IL 61021
Phone (815) 285-8520

215 E 1st St
Ste 117
Dixon, IL 61021
Phone (815) 285-5900

102 S Hennepin Ave
Ste 102
Dixon, IL 61021

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

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

Organizations & group practices 6

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.

Hospital & facility affiliations 3

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": "1601251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733875200000",
    "number": "1639786270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 S HENNEPIN AVE STE 102",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "610213077",
            "telephone_number": "815-288-7711",
            "fax_number": "815-285-8903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 S HENNEPIN AVE",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "610213013",
            "telephone_number": "815-288-7711",
            "fax_number": "815-285-8903"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "403 E 1st St",
            "address_purpose": "LOCATION",
            "city": "Dixon",
            "state": "IL",
            "postal_code": "610213116",
            "country_code": "US",
            "telephone_number": "815-288-5531",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FROST",
        "first_name": "MARISSA",
        "middle_name": "L",
        "credential": "APRN, CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-28",
        "last_updated": "2024-12-11",
        "certification_date": "2024-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.022022",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dixon, IL

Sources for this page

Verify at the official NPI Registry.