Individual provider Active NPI

Sharon R. Wissler, CNP

  • Nurse Practitioner
  • Pontiac, IL
National Provider Identifier
1700823556
Registry record updated Feb 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209004260 Issued in IL
Practice address
1506 W Reynolds St
Pontiac, IL 61764
Phone
(815) 844-6123
Fax
(815) 884-7851
NPI assigned
Jun 1, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 209004260 IL Primary
Adult Health Nurse Practitioner 363LA2200X 209004260 IL

Addresses

Primary practice location

1506 W Reynolds St
Pontiac, IL 61764

Mailing address

1506 W Reynolds St
Pontiac, IL 61764
Phone (815) 844-6123

Other identifiers 3

IdentifierTypeStateIssuer
05732097OtherILBCBS GROUP NUMBER
085507OtherILHEALTH ALLIANCE
833230OtherMEDICARE GROUP #

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
I20040412000282 IL Practitioner - Nurse Practitioner 4880688134 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

1506 W Reynolds St
Pontiac, IL 61764-9674
Phone (815) 844-6123

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Jan 1, 2016 Accepting new patients
Bromenn Healthcare, Inc. Past Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
Bromenn Physician Management Corporation Past Accepting new patients

Locations (25 of 30)

508 Iaa Dr
Bloomington, IL 61701
Phone (309) 451-2080

2200 E Washington St
Bloomington, IL 61701
Phone (309) 662-3311

210 Saint Joseph Dr
Bloomington, IL 61701
Phone (309) 663-5050

1505 Eastland Dr
Ste 320
Bloomington, IL 61701
Phone (309) 661-2368

2043 S Neil St
Champaign, IL 61820
Phone (217) 337-3852

1 N Logan Ave
Danville, IL 61832
Phone (217) 554-6827

3653 N Vermilion St
Danville, IL 61832
Phone (217) 554-6827

133 Spinder Dr
Ste 4015
East Peoria, IL 61611

2917 W 95th St
Evergreen Park, IL 60805
Phone (708) 907-4355

106 S 1st St
Fairbury, IL 61739
Phone (815) 635-3177

2779 Volunteer Dr
Ste 201
Galesburg, IL 61401
Phone (309) 345-9400

3315 W 115th St
Unit C
Merrionette Park, IL 60803
Phone (708) 907-4355

1715 N Division St
Ste 4D5E
Morris, IL 60450

853 W Jackson St
Morton, IL 61550

1765 Bradford Ln
Normal, IL 61761
Phone (309) 661-2400

211 Greenbriar Dr
Normal, IL 61761
Phone (309) 268-9807

1730 Bradford Ln
Normal, IL 61761
Phone (309) 451-2080

5660 W 95th St
Ste 1
Oak Lawn, IL 60453
Phone (708) 499-2273

6356 W 95th St
Oak Lawn, IL 60453
Phone (708) 907-4355

2911 Columbus St
Ottawa, IL 61350
Phone (815) 431-3410

2301 Court St
Pekin, IL 61554
Phone (303) 308-5100

3626 N Sheridan Rd
Peoria, IL 61604

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

10408 N Centerway Dr
Ste C
Peoria, IL 61615

5209 W War Memorial Dr
Peoria, IL 61615

Organizations & group practices 5

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.

Hospital & facility affiliations 2

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": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1298851200000",
    "number": "1700823556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1506 W REYNOLDS ST",
            "city": "PONTIAC",
            "state": "IL",
            "postal_code": "61764",
            "telephone_number": "815-844-6123",
            "fax_number": "815-884-7851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1506 W REYNOLDS ST",
            "city": "PONTIAC",
            "state": "IL",
            "postal_code": "61764",
            "telephone_number": "815-844-6123",
            "fax_number": "815-884-7851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISSLER",
        "first_name": "SHARON",
        "middle_name": "R.",
        "name_prefix": "Ms.",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-01",
        "last_updated": "2011-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209004260",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IL",
            "license": "209004260",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP NUMBER",
            "identifier": "05732097",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "085507",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP #",
            "identifier": "833230",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pontiac, IL

Sources for this page

Verify at the official NPI Registry.