Individual provider Active NPI

Stephanie Anne Butler, FNP-BC

  • Family Nurse Practitioner
  • Bloomington, IL
National Provider Identifier
1659650455
Registry record updated Apr 2, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209008930 Issued in IL
Practice address
1015 S Mercer Ave
Bloomington, IL 61701-7107
Phone
(309) 662-4321
NPI assigned
Aug 10, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2013

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 209008930 IL Primary

Addresses

Primary practice location

1015 S Mercer Ave
Bloomington, IL 61701-7107

Mailing address

1015 S Mercer Ave
Bloomington, IL 61701-7107
Phone (309) 662-4321

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
I20120125000783 IL Practitioner - Nurse Practitioner 7911174370 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Carle West Physician Group Inc CurrentSince Jul 1, 2020 Accepting new patients
Minuteclinic Diagnostic of Illinois PLLC Family CurrentSince Oct 6, 2011 Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Aug 4, 2014 Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Aug 4, 2014 Accepting new patients

Locations

2204 Eastland Dr
Bloomington, IL 61704
Phone (309) 662-9461

3024 E Empire St
Bloomington, IL 61704
Phone (309) 556-7500

1015 S Mercer Ave
Bloomington, IL 61701
Phone (309) 662-0088

1130 S Veterans Pkwy
Bloomington, IL 61704
Phone (309) 661-1839

214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160

29373 Network Pl
Chicago, IL 60673

75 Remittance Dr
Dept 1707
Chicago, IL 60675

75 Remittance Dr
Chicago, IL 60675

Interoperability endpoints

  • Direct secure messaging: sbutleraprn311066@carlehiedirect.net

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1312934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364860800000",
    "number": "1659650455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 S MERCER AVE",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617017107",
            "telephone_number": "309-662-4321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 S MERCER AVE",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617017107",
            "telephone_number": "309-662-4321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUTLER",
        "first_name": "STEPHANIE",
        "middle_name": "ANNE",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-10",
        "last_updated": "2013-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209008930",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IL

Sources for this page

Verify at the official NPI Registry.