Individual provider Active NPI

Pamela Pecenka, ANP

  • Nurse Practitioner
  • Peoria, IL
National Provider Identifier
1669418380
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Practice address
530 NE Glen Oak Ave
Peoria, IL 61637-0001
Phone
(309) 655-2323
NPI assigned
Jun 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 IL Primary

Addresses

Primary practice location

530 NE Glen Oak Ave
Peoria, IL 61637-0001

Mailing address

10335 N Port Washington Rd
250
Mequon, WI 53092-5763
Phone (262) 240-9870

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
I20060828000204 IL Practitioner - Nurse Practitioner 0345244794 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Healogics Specialty Physicians of Illinois, LLCGroup PAC ID 4486877511, 14 clinicians
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

2500 W Reynolds St
Suite 210
Pontiac, IL 61764-9774
Phone (309) 661-6230

3315 N Seminary St
St 101
Galesburg, IL 61401-1251
Phone (309) 344-1000

77 N Airlite St
Elgin, IL 60123-4912
Phone (847) 622-3407

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209004433ILMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Osf Multi-Specialty Group CurrentSince Jan 1, 2016 Accepting new patients
Osf Healthcare System Current Accepting new patients
Osf Healthcare System CurrentSince Feb 15, 2021 Accepting new patients
Healogics Specialty Physicians of Illinois, LLC Nurse Practitioner CurrentSince Sep 15, 2025 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Healthcare System CurrentSince Feb 15, 2021 Accepting new patients
Osf Healthcare System Past Accepting new patients

Locations

77 N Airlite St
Elgin, IL 60123
Phone (847) 622-3407

3315 N Seminary St
#101
Galesburg, IL 61401
Phone (309) 344-1000

3375 N Seminary St
Galesburg, IL 61401
Phone (309) 343-5114

3315 N Seminary St
Galesburg, IL 61401
Phone (309) 344-1000

107 Tremont St
Hopedale, IL 61747
Phone (309) 343-1000

1051 W South St
Kewanee, IL 61443
Phone (309) 734-3141

820 E Jackson St
Macomb, IL 61455
Phone (309) 343-1000

1000 W Harlem Ave
Monmouth, IL 61462
Phone (309) 734-1414

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

530 NE Glen Oak Ave
Peoria, IL 61637
Phone (309) 655-2553

124 SW Adams St
Peoria, IL 61602
Phone (309) 655-2850

Organizations & group practices 7

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 4

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": "1150848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1669418380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10335 N PORT WASHINGTON RD",
            "address_2": "250",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530925763",
            "telephone_number": "262-240-9870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616370001",
            "telephone_number": "309-655-2323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PECENKA",
        "first_name": "PAMELA",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.