Individual provider Active NPI

Jordyn M Hoemmen, WHNP

  • Nurse Practitioner
  • Alton, IL
National Provider Identifier
1649916875
Registry record updated May 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209024797 Issued in IL
Practice address
4 Memorial Dr Ste 125
Alton, IL 62002-6704
Phone
(618) 530-1454
NPI assigned
May 10, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2022

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 209024797 IL Primary

Addresses

Primary practice location

4 Memorial Dr Ste 125
Alton, IL 62002-6704

Mailing address

4 Memorial Dr Ste 125
Alton, IL 62002-6704

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)

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
I20220829002298 IL Practitioner - Nurse Practitioner 3870977622 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fairview Heights Medical Group SCGroup PAC ID 6800784083, 448 clinicians

Practice addresses (Care Compare)

4 Memorial Dr
Suite 125
Alton, IL 62002-6704
Phone (618) 433-6410

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Heights Medical Group SC CurrentSince Sep 11, 2022 Accepting new patients
Fairview Heights Medical Group SC CurrentSince Sep 11, 2022 Accepting new patients

Locations

1 Memorial Dr
Alton, IL 62002
Phone (618) 463-7240

4 Memorial Dr
Ste 125
Alton, IL 62002
Phone (618) 433-6410

2122 Troy Rd
Ste 130
Edwardsville, IL 62025
Phone (618) 692-9876

660 Mason Ridge Center Dr
Saint Louis, MO 63141
Phone (314) 273-6433

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1652140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652140800000",
    "number": "1649916875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 MEMORIAL DR STE 125",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620026704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 MEMORIAL DR STE 125",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620026704",
            "telephone_number": "618-530-1454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOEMMEN",
        "first_name": "JORDYN",
        "middle_name": "M",
        "credential": "WHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-10",
        "last_updated": "2022-05-10",
        "certification_date": "2022-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209024797",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4 Memorial Dr Ste 125",
            "city": "Alton",
            "state": "IL",
            "country_code": "US",
            "postal_code": "620026704",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Alton, IL

Sources for this page

Verify at the official NPI Registry.