Carrie H Kallal, MSN APRN

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

209021821 Issued in IL

Practice address

390 Maple Summit Rd
Illini BLDG
Jerseyville, IL 62052

Phone

(618) 498-2101

Fax

(618) 498-8153

NPI assigned

Aug 25, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Carrie H Purdy Former name

Electronic endpoints 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jersey Community Hospital

  dba JCH Medical Group - Jerseyville II

  • Rural Health Clinic/Center
  • Jerseyville, IL
  • NPI 1659750818
  NPD (past)

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

{
    "created_epoch": "1598313600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731456000000",
    "number": "1700499274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "390 MAPLE SUMMIT RD",
            "city": "JERSEYVILLE",
            "state": "IL",
            "postal_code": "620522000",
            "telephone_number": "618-498-7518",
            "fax_number": "618-498-3052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "390 MAPLE SUMMIT RD",
            "address_2": "ILLINI BLDG",
            "city": "JERSEYVILLE",
            "state": "IL",
            "postal_code": "62052",
            "telephone_number": "618-498-2101",
            "fax_number": "618-498-8153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KALLAL",
        "first_name": "CARRIE",
        "middle_name": "H",
        "credential": "MSN APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-25",
        "last_updated": "2024-11-13",
        "certification_date": "2024-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IL",
            "license": "209021821",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ckallal@jch.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "HIE JERSEY",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "390 Maple Summit Rd",
            "address_2": "Illini Bldg",
            "city": "Jerseyville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "62052",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "CARRIE",
            "last_name": "PURDY",
            "middle_name": "H",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Callie Johnson, LPC
• Jessica Johnson
• Maria Jordan
• Arturo Dungca Joson, M.D.
• Jennifer Julius
• Danielle Kanallakan
• Kidney and Hypertension Care Mid-America LLC
• Chelsie Kiel
• Isaac Thomas Kinney
• Tim C Kisabeth, MD

• Pediatric Nurse Practitioner in Jerseyville, IL
• Providers in Jerseyville, IL by specialty
• Pediatric Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.