Individual provider Active NPI

Andrew Bifulk, ACNPC-AG

  • Gerontology Nurse Practitioner
  • Peoria, IL
National Provider Identifier
1780356089
Registry record updated Jul 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
209024142 Issued in IL
Practice address
Osf Saint Francis Medical Center 530 NE Glen Oak Avenue
Peoria, IL 61637-0001
Phone
(309) 655-2000
NPI assigned
Oct 4, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 209024142 IL Primary

Addresses

Primary practice location

Osf Saint Francis Medical Center 530 NE Glen Oak Avenue
Peoria, IL 61637-0001

Mailing address

2017 E Ridge Rd
Beloit, WI 53511-3914
Phone (608) 316-0163

Other identifiers 1

IdentifierTypeStateIssuer
209.024142OtherILSTATE BOARD OF NURSING

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
I20211014000547 IL Practitioner - Nurse Practitioner 5799183281 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

200 E Pennsylvania Ave
Peoria, IL 61603-3089
Phone (309) 624-4000

Hospital & facility affiliations

  • Saint Francis Medical Center Hospital, Peoria, IL, CCN 140067

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209.024142ILMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Osf Multi-Specialty Group CurrentSince Oct 18, 2021 Accepting new patients
Osf Multi-Specialty Group CurrentSince Oct 18, 2021 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients

Locations

200 E Pennsylvania Ave
Peoria, IL 61603
Phone (309) 624-4000

530 NE Glen Oak Ave
Peoria, IL 61637
Phone (309) 655-2553

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

1001 Main St
Ste 400
Peoria, IL 61606
Phone (309) 308-0920

1001 Main St
Ste 200
Peoria, IL 61606
Phone (309) 308-2010

Organizations & group practices 3

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": "1633305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784505600000",
    "number": "1780356089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2017 E RIDGE RD",
            "city": "BELOIT",
            "state": "WI",
            "postal_code": "535113914",
            "telephone_number": "608-316-0163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "OSF SAINT FRANCIS MEDICAL CENTER 530 NE GLEN OAK AVENUE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616370001",
            "telephone_number": "309-655-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BIFULK",
        "first_name": "ANDREW",
        "credential": "ACNPC-AG",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-04",
        "last_updated": "2026-07-20",
        "certification_date": "2026-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IL",
            "license": "209024142",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE BOARD OF NURSING",
            "identifier": "209.024142",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.