Individual provider Active NPI

Jana Marie Lilyerd, ANP/GNP

  • Nurse Practitioner
  • Appleton, MN
National Provider Identifier
1710242300
Registry record updated Jul 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
R161003-3 Issued in MN
Practice address
30 S Behl St
Appleton, MN 56208-1616
Phone
(320) 289-2422
Fax
(320) 289-1585
NPI assigned
Jul 10, 2012
Last updated
Jul 10, 2012By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 10, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X R161003-3 MN Primary

Addresses

Primary practice location

30 S Behl St
Appleton, MN 56208-1616

Mailing address

30 S Behl St
Appleton, MN 56208-1616
Phone (320) 289-2422

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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
I20160629001121 ID Practitioner - Nurse Practitioner 9436307485 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Lukes Clinic-Treasure Valley LLCGroup PAC ID 4981878402, 1,155 clinicians

Practice addresses (Care Compare)

1210 NW 16TH St
Fruitland, ID 83619-2202
Phone (208) 452-8600

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R161003-3MNMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Clinic-Treasure Valley LLC CurrentSince Jun 2, 2016 Accepting new patients
St Lukes Regional Medical Center Past Accepting new patients

Locations

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2235

610 W Hays St
Boise, ID 83702
Phone (208) 345-3530

1210 NW 16th St
Fruitland, ID 83619
Phone (208) 452-8600

9850 W St Lukes Dr
Ste 129
Nampa, ID 83687
Phone (208) 205-7600

Interoperability endpoints

  • Direct secure messaging: jlilyerd40287@direct.slhs.org

Organizations & group practices 2

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 5

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": "1341878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1341878400000",
    "number": "1710242300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 S BEHL ST",
            "city": "APPLETON",
            "state": "MN",
            "postal_code": "562081616",
            "telephone_number": "320-289-2422",
            "fax_number": "320-289-1585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 S BEHL ST",
            "city": "APPLETON",
            "state": "MN",
            "postal_code": "562081616",
            "telephone_number": "320-289-2422",
            "fax_number": "320-289-1585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LILYERD",
        "first_name": "JANA",
        "middle_name": "MARIE",
        "credential": "ANP/GNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-10",
        "last_updated": "2012-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "R161003-3",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, MN

Sources for this page

Verify at the official NPI Registry.