Nicole Marie Chum, FNP-BC
Individual provider Active NPI Family Nurse Practitioner · Peru, IL
NPI 1699402016 · NPPES record last updated Aug 5, 2022
Key facts
- NPI
- 1699402016
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 209.025606 (IL)
- Practice address
- 920 West St Ste 216
Peru, IL 61354-2769 - Phone
- (309) 451-3376
- Fax
- (309) 452-3376
- NPI assigned
- Aug 5, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Dermatology and Mohs Surgery Institute LTD
Practice addresses (Care Compare)
530 Park Ave E
Suite 205
Princeton, IL 61356-3902
Phone (309) 451-3376
Hospital & facility affiliations
- Osf Saint Elizabeth MDL Ctr
- Osf Saint Clare Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 100 of 100
- Quality
- 100
- Improvement activities
- 40
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 |
|---|---|---|---|---|
| I20221121000174 | IL | Practitioner - Nurse Practitioner | 8426426651 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science - Nursing, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209.025606 | IL | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dermatology and Mohs Surgery Institute, LTD. | Current |
Accepting new patients | |
| Carle Bromenn Medical Center | Past | Accepting new patients |
Locations
303 N Hershey Rd
Ste D1
Bloomington, IL 61704
Phone (309) 268-3529
3024 E Empire St
Ste E
Bloomington, IL 61704
3024 E Empire St
Ste Ef
Bloomington, IL 61704
Phone (309) 556-7900
108 S Main Ste 4a
Canton, IL 61520
100 Deerpath
Charleston, IL 61920
Phone (217) 345-2727
422 W White St
Clinton, IL 61727
Phone (217) 935-9570
101 S Major St
Eureka, IL 61530
Phone (309) 268-2172
1120 N Melvin St
Gibson City, IL 60936
Phone (217) 355-1684
1200 N State Route 121
Mt Zion, IL 62549
Phone (217) 864-5531
9118 N Lindbergh Dr
Peoria, IL 61615
Phone (309) 693-3993
920 West St
Ste 216
Peru, IL 61354
Phone (815) 220-0898
2500 W Reynolds St
Ste 210
Pontiac, IL 61764
Phone (309) 661-6230
530 Park Ave E
Ste 205
Princeton, IL 61356
Phone (815) 872-9491
111 Spring St
Fl 5
Streator, IL 61364
Phone (815) 673-2353
302 Innovation Dr
Ste 400
Franklin, TN 37067
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 209.025606 | IL | Yes |
Addresses
Primary practice location
920 West St Ste 216
Peru, IL 61354-2769
Mailing address
1986 N 2919TH Rd
Marseilles, IL 61341-9002
Phone (815) 343-4494
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 209.025606 | Other | IL | STATE OF ILLINOIS APRN LICENSE |
Other providers in Peru, IL
- Lee Michael Ceresa
- Chicago Hearing LLC
- Dale R Chilson
- Catherine A Christensen
- Keith Christensen
- City Center Physical Therapy - Peru, Inc.
- City Center Rehabilitation West - Inc.
- CMS & S LTD.
- Julie A Condie
- Constantino Perales Jr., M.D.
All providers in Peru, IL · Family 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 Aug 5, 2022. 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.