Individual provider Active NPI

Rachel Jordan, APRN

  • Primary Care Nurse Practitioner
  • Granite City, IL
National Provider Identifier
1700682473
Registry record updated May 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
209031435 Issued in IL
Practice address
3912 Maryville Rd
Granite City, IL 62040-4179
Phone
(618) 931-1335
NPI assigned
Feb 21, 2025
Last updated
May 22, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X 209031435 IL Primary

Addresses

Primary practice location

3912 Maryville Rd
Granite City, IL 62040-4179

Mailing address

3912 Maryville Rd
Granite City, IL 62040
Phone (618) 931-1335

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20250604000160 IL Practitioner - Nurse Practitioner 4284143967 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
May accept Medicare assignment
Group practices
Ahs Il Medical Group LLCGroup PAC ID 5496111676, 46 clinicians

Practice addresses (Care Compare)

3912 Maryville Rd
Granite City, IL 62040-4179
Phone (618) 931-1335

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209031435ILMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ahs Il Medical Group LLC CurrentSince Apr 1, 2025 Accepting new patients

Locations

1 Saint Anthonys Way
Alton, IL 62002
Phone (618) 233-6870

2044 Madison Ave
Ste 15
Granite City, IL 62040
Phone (618) 451-1500

2100 Madison Ave
Ste 301
Granite City, IL 62040

3912 Maryville Rd
Granite City, IL 62040
Phone (618) 931-1335

8 Doctors Park Rd
Mount Vernon, IL 62864
Phone (618) 244-5500

Interoperability endpoints

  • Direct secure messaging: rachel.jordan.1@28328.direct.athenahealth.com

Organizations & group practices 1

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.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1740096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747872000000",
    "number": "1700682473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3912 MARYVILLE RD",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "62040",
            "telephone_number": "618-931-1335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3912 MARYVILLE RD",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620404179",
            "telephone_number": "618-931-1335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "RACHEL",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-02-21",
        "last_updated": "2025-05-22",
        "certification_date": "2025-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "IL",
            "license": "209031435",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Granite City, IL

Sources for this page

Verify at the official NPI Registry.