Individual provider Active NPI

Courtney Meghann Reynolds, APN

  • Family Nurse Practitioner
  • Canton, IL
National Provider Identifier
1720775919
Registry record updated Apr 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209027209 Issued in IL
Practice address
180 S Main St
Canton, IL 61520-2608
Phone
(309) 647-0201
NPI assigned
Apr 19, 2023
Last updated
Apr 19, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209027209 IL Primary

Addresses

Primary practice location

180 S Main St
Canton, IL 61520-2608

Mailing address

180 S Main St
Canton, IL 61520-2608
Phone (309) 647-0201

Other practice location 1

601 E Fort St
Farmington, IL 61531-1338
Phone (309) 245-2406

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
I20230816001530 IL Practitioner - Nurse Practitioner 8820450356 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Graham Hospital AssociationGroup PAC ID 2769375021, 124 clinicians

Practice addresses (Care Compare)

601 E Fort St
Farmington, IL 61531-1338
Phone (309) 647-0201

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.26 of 100Reported as group
Quality
62.57
Promoting interoperability
100
Improvement activities
40
Cost
77.37

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209027209ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Graham Hospital Association CurrentSince Jun 26, 2023 Accepting new patients
Graham Hospital Association Current Accepting new patients
Graham Hospital Association CurrentSince Jun 26, 2023 Accepting new patients

Locations

175 S Main St
Canton, IL 61520
Phone (309) 647-3937

180 S Main St
Canton, IL 61520
Phone (309) 647-5240

1024 N Magnolia St
Elmwood, IL 61529
Phone (309) 742-6334

601 E Fort St
Farmington, IL 61531
Phone (309) 245-2406

Organizations & group practices 4

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 1

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": "1681862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681862400000",
    "number": "1720775919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 S MAIN ST",
            "city": "CANTON",
            "state": "IL",
            "postal_code": "615202608",
            "telephone_number": "309-647-0201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 S MAIN ST",
            "city": "CANTON",
            "state": "IL",
            "postal_code": "615202608",
            "telephone_number": "309-647-0201"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "601 E Fort St",
            "address_purpose": "LOCATION",
            "city": "Farmington",
            "state": "IL",
            "postal_code": "615311338",
            "country_code": "US",
            "telephone_number": "309-245-2406",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "COURTNEY",
        "middle_name": "MEGHANN",
        "name_prefix": "Mrs.",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-19",
        "last_updated": "2023-04-19",
        "certification_date": "2023-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209027209",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, IL

Sources for this page

Verify at the official NPI Registry.