Individual provider Active NPI

Stefanie Lynn Simmons, FNP

  • Family Nurse Practitioner
  • Bourbonnais, IL
National Provider Identifier
1770172611
Registry record updated Jul 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
041343623 Issued in IL
Practice address
662 N Convent St
Bourbonnais, IL 60914-1332
Phone
(815) 802-0088
NPI assigned
Jan 14, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 041343623 IL Primary
Family Nurse Practitioner 363LF0000X 277003646 IL

Addresses

Primary practice location

662 N Convent St
Bourbonnais, IL 60914-1332

Mailing address

184 S Fulton Ave
Bradley, IL 60915-2316
Phone (815) 955-5710

Other practice location 1

380 W North St
Manhattan, IL 60442-9839
Phone (815) 802-0077

Other practice location 2

184 S Fulton Ave
Bradley, IL 60915-2316
Phone (815) 955-5710

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
I20210628000435 IL Practitioner - Nurse Practitioner 2961803051 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Midwest Express Care 2, IncGroup PAC ID 0547495467, 221 clinicians

Practice addresses (Care Compare)

40 75TH St
Willowbrook, IL 60527-2325
Phone (630) 581-5372

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
041343623ILMDNurse Practitioner
209.022711ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Express Care 2, Inc CurrentSince Jun 1, 2021 Accepting new patients
Midwest Express Care 2, Inc CurrentSince Jun 1, 2021 Accepting new patients

Locations

12200 Western Ave
Blue Island, IL 60406
Phone (630) 581-5372

40 75th St
Willowbrook, IL 60527
Phone (630) 326-5312

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1610582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784073600000",
    "number": "1770172611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "184 S FULTON AVE",
            "city": "BRADLEY",
            "state": "IL",
            "postal_code": "609152316",
            "telephone_number": "815-955-5710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "662 N CONVENT ST",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609141332",
            "telephone_number": "815-802-0088"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "380 W North St",
            "address_purpose": "LOCATION",
            "city": "Manhattan",
            "state": "IL",
            "postal_code": "604429839",
            "country_code": "US",
            "telephone_number": "815-802-0077",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "184 S Fulton Ave",
            "address_purpose": "LOCATION",
            "city": "Bradley",
            "state": "IL",
            "postal_code": "609152316",
            "country_code": "US",
            "telephone_number": "815-955-5710",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIMMONS",
        "first_name": "STEFANIE",
        "middle_name": "LYNN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-14",
        "last_updated": "2026-07-15",
        "certification_date": "2026-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "041343623",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "277003646",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bourbonnais, IL

Sources for this page

Verify at the official NPI Registry.