Individual provider Active NPI

Justine E Mucci, APRN, CNP

  • Family Nurse Practitioner
  • Ottawa, IL
National Provider Identifier
1659771863
Registry record updated Apr 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
277002469 Issued in IL
Practice address
1614 E Norris Dr
Ottawa, IL 61350-3681
Phone
(815) 433-1010
NPI assigned
Aug 26, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 277002469 IL Primary
Nurse Practitioner 363L00000X 209-011746 IL

Addresses

Primary practice location

1614 E Norris Dr
Ottawa, IL 61350-3681

Mailing address

1640 1St Ave
Ottawa, IL 61350-9214
Phone (815) 431-9208

Other names 1

  • Justine E Fitzmaurice Former name

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
I20141007000325 IL Practitioner - Nurse Practitioner 6305066754 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ottawa Regional Hospital and Healthcare CenterGroup PAC ID 9133029861, 47 clinicians

Practice addresses (Care Compare)

1100 E Norris Dr
Ottawa, IL 61350-1604
Phone (815) 433-3100

1640 1St Ave
Ottawa, IL 61350-9214
Phone (815) 431-9208

Hospital & facility affiliations

  • Osf Saint Elizabeth MDL Ctr Hospital, Peru, IL, CCN 140110

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209-011746ILMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ottawa Regional Hospital & Healthcare Center CurrentSince Dec 1, 2022 Accepting new patients
Mendota Community Hospital Nurse Practitioner Current Accepting new patients
Mendota Community Hospital CurrentSince Apr 18, 2025 Accepting new patients
Osf Multi-Specialty Group CurrentSince Jan 1, 2016 Accepting new patients
Ottawa Regional Hospital & Healthcare Center CurrentSince Dec 1, 2022 Accepting new patients
Mendota Community Hospital CurrentSince Apr 18, 2025 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Ottawa Regional Hospital & Healthcare Center Past Accepting new patients

Locations

102 11th St
Marseilles, IL 61341
Phone (815) 795-5400

1405 E 12th St
Ste 600
Mendota, IL 61342
Phone (815) 538-7200

1405 E 12th St
Ste 300
Mendota, IL 61342
Phone (815) 538-7200

1404 Washington St
Mendota, IL 61342
Phone (815) 538-1825

1640 1st Ave
Ottawa, IL 61350
Phone (815) 431-9208

1100 E Norris Dr
Ottawa, IL 61350
Phone (815) 416-1224

1050 E Norris Dr
Ste 3A
Ottawa, IL 61350
Phone (815) 431-5746

1614 E Norris Dr
Ottawa, IL 61350
Phone (815) 433-1010

5114 N Glen Park Place Rd
Peoria, IL 61614
Phone (309) 655-2431

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

111 Spring St
Fl 4
Streator, IL 61364
Phone (815) 672-4587

Organizations & group practices 9

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 1

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": "1409011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744934400000",
    "number": "1659771863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1640 1ST AVE",
            "city": "OTTAWA",
            "state": "IL",
            "postal_code": "613509214",
            "telephone_number": "815-431-9208",
            "fax_number": "815-673-5308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1614 E NORRIS DR",
            "city": "OTTAWA",
            "state": "IL",
            "postal_code": "613503681",
            "telephone_number": "815-433-1010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUCCI",
        "first_name": "JUSTINE",
        "middle_name": "E",
        "credential": "APRN, CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-26",
        "last_updated": "2025-04-18",
        "certification_date": "2025-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "277002469",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209-011746",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JUSTINE",
            "last_name": "FITZMAURICE",
            "middle_name": "E",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Ottawa, IL

Sources for this page

Verify at the official NPI Registry.