Jaime Renee Mendoza, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

27700144 Issued in IL

Practice address

6805 State Route 162 Ste 201
Maryville, IL 62062

Phone

(618) 288-5019

Fax

(618) 288-5059

NPI assigned

Mar 13, 2013

Last updated

Jan 21, 2026By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Southern Illinois Associates LLCGroup PAC ID 2961489992, 16 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/17590/brand/1/csg/1/fhir/r4
• FHIR API: https://fhir4.healow.com/fhir/r4/AFHDDD

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 Associates LLC

  • Psychiatry Physician
  • Maryville, IL
  • NPI 1962427856

  Family

  Medicare reassignment Care Compare group NPD
• Empower Psychiatric Health and Wellness PLCC

  • Psychiatric/Mental Health Nurse Practitioner
  • Edwardsville, IL
  • NPI 1780549253
  NPD Authorized official
• Psychiatric Urgent Care LLC

  • Urgent Care Clinic/Center
  • Maryville, IL
  • NPI 1134843451
  NPD
• Koen Counseling and Wellness Center

  • Mental Health Counselor
  • Herrin, IL
  • NPI 1952050460
  NPD (past)

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

{
    "created_epoch": "1363132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768953600000",
    "number": "1689915811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "322 S BUCHANAN ST",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620252086",
            "telephone_number": "618-498-0190",
            "fax_number": "618-417-6049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6805 STATE ROUTE 162 STE 201",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "62062",
            "telephone_number": "618-288-5019",
            "fax_number": "618-288-5059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDOZA",
        "first_name": "JAIME",
        "middle_name": "RENEE",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-03-13",
        "last_updated": "2026-01-21",
        "certification_date": "2026-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209010309",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "27700144",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katrina McNair-Smith, MS,CCC-A
• Anna McNamara, PT, DPT
• McPherson Medical & Diagnostic LLC (American Medical Missouri)
• Med Plus Physical Medicine LLC
• Holly Mellenthin
• Mercy Clinic Specialists Services-Illinois LLC
• Mercy Clinic Surgical Specialists-Illinois LLC
• Heather Rae Merkle, LCPC
• Natalie Messina
• Metro East Healthcare Limited

• Psychiatric/Mental Health Nurse Practitioner in Maryville, IL
• Providers in Maryville, 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 Jan 21, 2026; 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.