Nicole Andrea Bennett, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

209030085 Issued in IL

Practice address

2 Terminal Dr Ste 8
East Alton, IL 62024-2294

Phone

(618) 259-0365

Fax

(618) 259-2495

NPI assigned

Jan 26, 2021

Last updated

Aug 7, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

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

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern Illinois Healthcare Foundation IncGroup PAC ID 1456256874, 117 clinicians

Touchette Regional Hospital IncGroup PAC ID 7416843370, 46 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Touchette Regional Hospital Inc Hospital, Centreville, IL, CCN 140077

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nicole.bennett.1@9559.direct.athenahealth.com

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.

• Southern Illinois Healthcare Foundation Inc

  dba Centreville Health Center

  • Federally Qualified Health Center (FQHC)
  • Centreville, IL
  • NPI 1609813500
  Medicare reassignment Care Compare group NPD
• Touchette Regional Hospital Inc

  • Emergency Medicine Physician
  • Cahokia Heights, IL
  • NPI 1922019926
  Medicare reassignment Care Compare group NPD
• Southern Illinois Health Care Foundation, Inc.

  dba Belleville Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Belleville, IL
  • NPI 1780609578
  NPD
• Southern Illinois Healthcare Foundation Inc

  dba SIHF Healthcare

  • Federally Qualified Health Center (FQHC)
  • Waterloo, IL
  • NPI 1821813247
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Touchette Regional Hospital Inc

  dba Touchette Geriatric Behavioral Health Services

  • Psychiatric Hospital Unit
  • Cahokia Heights, IL
  • NPI 1750992459
  Care Compare affiliation
• Touchette Regional Hospital Inc

  • Emergency Medicine Physician
  • Cahokia Heights, IL
  • NPI 1922019926

  Hospital

  Care Compare affiliation
• Touchette Regional Hospital, Inc.

  • General Acute Care Hospital
  • Cahokia Heights, IL
  • NPI 1427111046
  Care Compare affiliation

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

{
    "created_epoch": "1611619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722988800000",
    "number": "1679163372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 TERMINAL DR STE 8",
            "city": "EAST ALTON",
            "state": "IL",
            "postal_code": "620242294",
            "telephone_number": "618-259-0365",
            "fax_number": "618-259-2495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 TERMINAL DR STE 8",
            "city": "EAST ALTON",
            "state": "IL",
            "postal_code": "620242294",
            "telephone_number": "618-259-0365",
            "fax_number": "618-259-2495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "NICOLE",
        "middle_name": "ANDREA",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-26",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "209030085",
            "primary": true
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "MO",
            "license": "2018036588",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RN",
            "identifier": "2018036588",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RN",
            "identifier": "041470020",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Affordable Dentistry Today, PC (Affordable Dentistry Today - East Alton)
• Airline Care Clinic PLLC
• Toni Renee Ashley
• Bellwood Family Dental
• Bellwood Family Dentistry
• Bridge of Hope Counseling Services PC
• Sydney Burk, OTR/L
• Katherine Burton, RN
• Centerstone of Illinois, Inc
• Centerstone of Illinois, Inc

• Psychiatric/Mental Health Nurse Practitioner in East Alton, IL
• Providers in East Alton, IL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.