Nathan Eugene Kellenberger, APRN-C
Individual provider Active NPI Family Nurse Practitioner · Peoria, IL
NPI 1720798341 · NPPES record last updated Dec 5, 2022
Key facts
- NPI
- 1720798341
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 209.026515 (IL)
- Practice address
- 5114 N Glen Park Place Rd
Peoria, IL 61614-4686 - Phone
- (309) 655-2431
- NPI assigned
- Dec 5, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 18
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Saint James Hospital
Osf Multi-Specialty Group
Practice addresses (Care Compare)
111 Spring St
FL 4
Streator, IL 61364-3332
Phone (815) 672-4587
5114 N Glen Park Place Rd
Peoria, IL 61614-4686
Phone (309) 683-8156
8600 State Route 91
Suite 130
Peoria, IL 61615-7829
Phone (309) 683-5050
8800 State Route 91
Peoria, IL 61615-9473
Phone (309) 683-5000
Hospital & facility affiliations
- Saint Francis Medical Center
- Osf Saint Elizabeth MDL Ctr
- Saint James Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221216000741 | IL | Practitioner - Nurse Practitioner | 3072982883 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209.026515 | IL | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Central PA Pharmacy LLC. | Current | Accepting new patients | |
| Osf Multi-Specialty Group | Current |
Accepting new patients | |
| Saint James Hospital | Current |
Accepting new patients | |
| Saint James Hospital | Current |
Accepting new patients | |
| Cardinal Medical Group, LTD. | Past | Accepting new patients | |
| Saint James Hospital | Past | Accepting new patients |
Locations (25 of 30)
508 Iaa Dr
Bloomington, IL 61701
Phone (309) 451-2080
1505 Eastland Dr
Ste 1100
Bloomington, IL 61701
Phone (309) 663-2100
2043 S Neil St
Champaign, IL 61820
Phone (217) 337-3852
3653 N Vermilion St
Danville, IL 61832
Phone (217) 554-6827
1 N Logan Ave
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
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 4D
Morris, IL 60450
435 Maxine Dr
Morton, IL 61550
Phone (309) 263-2424
853 W Jackson St
Morton, IL 61550
211 Greenbriar Dr
Normal, IL 61761
Phone (309) 268-9807
1730 Bradford Ln
Normal, IL 61761
Phone (309) 451-2080
2200 Fort Jesse Rd
Ste 100
Normal, IL 61761
Phone (309) 661-6280
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
8800 State Route 91
Peoria, IL 61615
Phone (309) 683-5000
5905 N Prospect Rd
Peoria, IL 61614
3626 N Sheridan Rd
Peoria, IL 61604
8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050
5209 W War Memorial Dr
Peoria, IL 61615
5114 N Glen Park Place Rd
Peoria, IL 61614
Phone (309) 655-2431
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 209.026515 | IL | Yes |
Addresses
Primary practice location
5114 N Glen Park Place Rd
Peoria, IL 61614-4686
Mailing address
5114 N Glen Park Place Rd
Peoria, IL 61614-4686
Phone (309) 655-2431
Other providers in Peoria, IL
- Michele Jane Keith
- Kelch Chiropractic Inc.
- Amy N Kelch-Cohen
- Robert Daniel Kelch
- Gidget Kellenberger
- Kimberly Ann Kelley
- Amanda Marie Kelly
- Calista R Kelly
- Janelle Leann Kelly
- Jody L Kelly
All providers in Peoria, IL · Family Nurse Practitioner in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 5, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.