Individual provider Active NPI

Angela J Gilles, MSFNP

  • Family Nurse Practitioner
  • Morton, IL
National Provider Identifier
1770539611
Registry record updated Aug 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209005284 Issued in IL
Practice address
411 Maxine Dr
Morton, IL 61550-2495
Phone
(309) 263-2411
Fax
(309) 263-2208
NPI assigned
May 25, 2006
Last updated
Aug 20, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2010

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 209005284 IL Primary

Addresses

Primary practice location

411 Maxine Dr
Morton, IL 61550-2495

Mailing address

411 Maxine Dr
Morton, IL 61550-2495

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
I20041201000140 IL Practitioner - Nurse Practitioner 2062477060 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Koch Family Medicine SCGroup PAC ID 1153378229, 8 clinicians

Practice addresses (Care Compare)

411 Maxine Dr
Morton, IL 61550-2495
Phone (309) 263-2411

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.74 of 100Reported as group
Quality
74.86
Improvement activities
40
Cost
79.33

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Koch Family Medicine SC CurrentSince Jun 13, 2005 Accepting new patients
Mark C. Baylor, M.D. Past Accepting new patients

Locations

411 Maxine Dr
Morton, IL 61550
Phone (309) 263-2411

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 4

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": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1282262400000",
    "number": "1770539611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 MAXINE DR",
            "city": "MORTON",
            "state": "IL",
            "postal_code": "615502495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 MAXINE DR",
            "city": "MORTON",
            "state": "IL",
            "postal_code": "615502495",
            "telephone_number": "309-263-2411",
            "fax_number": "309-263-2208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLES",
        "first_name": "ANGELA",
        "middle_name": "J",
        "credential": "MSFNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-25",
        "last_updated": "2010-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209005284",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Morton, IL

Sources for this page

Verify at the official NPI Registry.