Laci Christine Jankowski, APN
Individual provider Active NPI Adult Health Nurse Practitioner · Mount Vernon, IL
NPI 1689945339 · NPPES record last updated Jan 5, 2021
Key facts
- NPI
- 1689945339
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Health Nurse Practitioner 363LA2200X
- License
- 041-398735 (IL)
- Practice address
- 1501 McPherson Ave
Mount Vernon, IL 62864-2831 - Phone
- (618) 241-1360
- Fax
- (618) 241-1865
- NPI assigned
- Jan 25, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Physician Services Corporation of Southern Illinois Inc
Practice addresses (Care Compare)
2 Good Samaritan Way
Suite 220
Mount Vernon, IL 62864-2476
Phone (618) 899-3900
Hospital & facility affiliations
- Good Samaritan Regional HLTH Center
- SSM Health St Mary'S Hospital -Centralia
- Franklin Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120309000145 | IL | Practitioner - Nurse Practitioner | 7214196336 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 041-398735 | IL | MD | Adult Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physician Services Corporation of Southern Illinois Inc. | Current |
Accepting new patients |
Locations
7420 Solutions Ctr
Chicago, IL 60677
Phone (314) 989-3155
2 Good Samaritan Way
Ste 220
Mount Vernon, IL 62864
Phone (618) 899-3900
1501 McPherson Ave
Mount Vernon, IL 62864
Phone (618) 241-1360
2 Good Samaritan Way
Ste 320
Mount Vernon, IL 62864
Phone (618) 899-1944
605 N 12th St
Mount Vernon, IL 62864
Phone (618) 241-2200
1 Good Samaritan Way
Mount Vernon, IL 62864
Phone (618) 242-4600
Interoperability endpoints
- ljankowski76635@direct-ehr-ssmhc.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 041-398735 | IL | Yes |
Addresses
Primary practice location
1501 McPherson Ave
Mount Vernon, IL 62864-2831
Mailing address
490 W Lebanon St
Nashville, IL 62263-1349
Phone (618) 521-1657
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 041-398735 | Other | IL | STATE OF ILLINOIS LICENSES NUMBER |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | ljankowski76635@direct-ehr-ssmhc.com | Direct | |
| FHIR URL | https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ | Other |
Other providers in Mount Vernon, IL
- J Bass LTD
- Jacob S Jackson
- Kristen Jacobs
- Jacques Papazian M.D,S.C.
- Vipin K Jain
- Cassidy Jo Jansen
- JCRX Mental Health Services PLLC
- Jefferson County
- Jefferson County Comprehensive
- Jefferson County Comprehensive
All providers in Mount Vernon, IL · Adult Health Nurse Practitioner in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 5, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.