Individual provider Active NPI

Dorthia D Cameron, NP

  • Primary Care Nurse Practitioner
  • Peoria, IL
National Provider Identifier
1669838496
Registry record updated Jul 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
209030955 Issued in IL
Practice address
530 NE Glen Oak Ave
Peoria, IL 61637-0001
Phone
(309) 624-8820
Fax
(309) 624-8820
NPI assigned
Jan 9, 2016
Last updated
Jul 28, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 6647 WI
Primary Care Nurse Practitioner 363LP2300X 209030955 IL Primary

Addresses

Primary practice location

530 NE Glen Oak Ave
Peoria, IL 61637-0001

Mailing address

530 NE Glen Oak Ave
Peoria, IL 61637-0001
Phone (309) 624-8820

Other practice location 1

10400 75th St
Kenosha, WI 53142-7884
Phone (262) 948-7000

Other practice location 2

10400 75th St
Kenosha, WI 53142-7884
Phone (262) 948-7000

Other practice location 3

2514 S 102nd St Ste 160
West Allis, WI 53227-2142
Phone (414) 255-0300

Other identifiers 1

IdentifierTypeStateIssuer
100054093MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address dwilson102724@aurora.direct-ci.com Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20160309000814 WI Practitioner - Nurse Practitioner 8022314582 Reassigns benefits to 6 organizations
I20250414003245 IL Practitioner - Nurse Practitioner 8022314582 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
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)

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

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209030955ILMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Vpa PC Current Accepting new patients
Maple Medical SC CurrentSince Feb 1, 2024 Accepting new patients
Vpa PC CurrentSince Mar 1, 2020 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Vpa PC CurrentSince Mar 1, 2020 Accepting new patients
Vpa PC Current Accepting new patients
Oak Medical SC CurrentSince Feb 1, 2024 Accepting new patients
Iah of Wisconsin, PLLC CurrentSince Mar 1, 2020 Accepting new patients
Osf Multi-Specialty Group CurrentSince Jan 1, 2025 Accepting new patients
Milwaukee Cardiac Care LLC CurrentSince Feb 1, 2016 Accepting new patients
Bellin Memorial Hospital Inc Past Accepting new patients

Locations

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

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

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

500 Kirts Blvd
Ste 100
Troy, MI 48084
Phone (214) 824-6000

13555 Bishops Ct
Ste 315
Brookfield, WI 53005
Phone (414) 255-0300

744 S Webster Ave
#2
Green Bay, WI 54301

110 Belmont Rd
Madison, WI 53714
Phone (308) 249-7391

2603 W Rawson Ave
Ste 135
Oak Creek, WI 53154
Phone (414) 271-8181

N20W22961 Watertown Rd
Waukesha, WI 53186
Phone (262) 875-5070

2514 S 102nd St
Ste 160
West Allis, WI 53227
Phone (414) 255-0300

Interoperability endpoints

  • Direct secure messaging: dwilson102724@aurora.direct-ci.com

Organizations & group practices 11

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": "1452297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753660800000",
    "number": "1669838496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616370001",
            "telephone_number": "309-624-8820",
            "fax_number": "309-624-8820"
        },
        {
            "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": "309-624-8820",
            "fax_number": "309-624-8820"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10400 75th St",
            "address_purpose": "LOCATION",
            "city": "Kenosha",
            "state": "WI",
            "postal_code": "531427884",
            "country_code": "US",
            "telephone_number": "262-948-7000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10400 75th St",
            "address_purpose": "LOCATION",
            "city": "Kenosha",
            "state": "WI",
            "postal_code": "531427884",
            "country_code": "US",
            "telephone_number": "262-948-7000",
            "fax_number": "414-385-4436",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2514 S 102nd St Ste 160",
            "address_purpose": "LOCATION",
            "city": "West Allis",
            "state": "WI",
            "postal_code": "532272142",
            "country_code": "US",
            "telephone_number": "414-255-0300",
            "fax_number": "414-543-9601",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CAMERON",
        "first_name": "DORTHIA",
        "middle_name": "D",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-09",
        "last_updated": "2025-07-28",
        "certification_date": "2025-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "6647",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "IL",
            "license": "209030955",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100054093",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dwilson102724@aurora.direct-ci.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "10400 75th St",
            "city": "Kenosha",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531427884",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "10400 75th St",
            "city": "Kenosha",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531427884",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.