Individual provider Active NPI

Kevin Spangler, APN

  • Family Nurse Practitioner
  • Peoria Heights, IL
National Provider Identifier
1659790350
Registry record updated Aug 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209017904 Issued in IL
Practice address
1120 E War Memorial Dr
Peoria Heights, IL 61616
Phone
(309) 685-4411
NPI assigned
Apr 9, 2014
Last updated
Aug 15, 2018By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 15, 2018

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 209017904 IL Primary

Addresses

Primary practice location

1120 E War Memorial Dr
Peoria Heights, IL 61616

Mailing address

1120 E War Memorial Dr
Peoria Heights, IL 61616-7757
Phone (309) 685-4411

Other identifiers 1

IdentifierTypeStateIssuer
209017904OtherILLICENSE

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
I20181106000245 IL Practitioner - Nurse Practitioner 9739404591 Reassigns benefits to 5 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
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

5114 N Glen Park Place Rd
Peoria, IL 61614-4686
Phone (309) 683-8156

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

8800 State Route 91
Peoria, IL 61615-9473
Phone (309) 683-5000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209017904ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Proctor Health Systems Current Accepting new patients
Methodist Medical Center of Illinois Family CurrentSince Aug 1, 2018 Accepting new patients
Methodist Medical Center of Illinois CurrentSince Aug 1, 2018 Accepting new patients
Proctor Health Systems CurrentSince Aug 1, 2018 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Proctor Health Systems CurrentSince Aug 1, 2018 Accepting new patients
Osf Multi-Specialty Group CurrentSince Feb 1, 2019 Accepting new patients
Pekin Prohealth Inc CurrentSince Sep 10, 2018 Accepting new patients
Methodist Medical Center of Illinois Current Accepting new patients

Locations

2535 E Washington St
East Peoria, IL 61611
Phone (309) 694-6464

600 S 13th St
Pekin, IL 61554
Phone (309) 347-1151

112 NE Crescent Ave
Peoria, IL 61606
Phone (309) 696-9857

120 NE Glen Oak Ave
Ste 400
Peoria, IL 61603
Phone (309) 671-3519

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

221 NE Glen Oak Ave
Peoria, IL 61636
Phone (309) 672-4281

3915 Barring Trce
Peoria, IL 61615
Phone (309) 689-3030

5401 N Knoxville Ave
Ste 400
Peoria, IL 61614
Phone (309) 691-6610

815 Main St
Ste A
Peoria, IL 61602
Phone (309) 671-3000

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

8914 N Knoxville Ave
Peoria, IL 61615
Phone (309) 691-9110

1120 E War Memorial Dr
Peoria Hts, IL 61616
Phone (309) 685-1774

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1397001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534291200000",
    "number": "1659790350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 E WAR MEMORIAL DR",
            "city": "PEORIA HEIGHTS",
            "state": "IL",
            "postal_code": "616167757",
            "telephone_number": "309-685-4411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 E WAR MEMORIAL DR",
            "city": "PEORIA HEIGHTS",
            "state": "IL",
            "postal_code": "61616",
            "telephone_number": "309-685-4411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPANGLER",
        "first_name": "KEVIN",
        "credential": "APN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-04-09",
        "last_updated": "2018-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209017904",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "209017904",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria Heights, IL

Sources for this page

Verify at the official NPI Registry.