Individual provider Active NPI

Jenae Roseland, ARNP

  • Pediatric Nurse Practitioner
  • Peoria, IL
National Provider Identifier
1811505282
Registry record updated Aug 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
209023939 Issued in IL
Practice address
420 NE Glen Oak Ave Ste 301
Peoria, IL 61603-3112
Phone
(309) 655-3453
NPI assigned
Jul 21, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 209023939 IL Primary
Critical Care Pediatric Nurse Practitioner 363LP0222X C159713 IA

Addresses

Primary practice location

420 NE Glen Oak Ave Ste 301
Peoria, IL 61603-3112

Mailing address

420 NE Glen Oak Ave Ste 301
Peoria, IL 61603-3112
Phone (309) 655-3453

Other practice location 1

200 Hawkins Dr
Iowa City, IA 52242-1009
Phone (319) 356-1616

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
I20211109000175 IL Practitioner - Nurse Practitioner 0446677959 Reassigns benefits to 2 organizations

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

Practice addresses (Care Compare)

1 Illini Dr
Peoria, IL 61605-2576
Phone (309) 671-3173

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209023939ILMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Board of Trustees of the University of Illinois Current Accepting new patients
Board of Trustees of the University of Illinois CurrentSince Dec 6, 2021 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Nov 2, 2021 Accepting new patients
The Board of Trustees of the University of Illinois CurrentSince Dec 6, 2021 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

7694 Solutions Ctr
Chicago, IL 60677

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

1 Illini Dr
Peoria, IL 61605
Phone (309) 671-3000

420 NE Glen Oak Ave
Ste 301
Peoria, IL 61603
Phone (309) 655-7668

444 Roxbury Rd
#12471
Rockford, IL 61107

Organizations & group practices 6

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": "1595289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724716800000",
    "number": "1811505282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 NE GLEN OAK AVE STE 301",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616033112",
            "telephone_number": "309-655-3453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 NE GLEN OAK AVE STE 301",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616033112",
            "telephone_number": "309-655-3453"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Hawkins Dr",
            "address_purpose": "LOCATION",
            "city": "Iowa City",
            "state": "IA",
            "postal_code": "522421009",
            "country_code": "US",
            "telephone_number": "319-356-1616",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROSELAND",
        "first_name": "JENAE",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-21",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IL",
            "license": "209023939",
            "primary": true
        },
        {
            "code": "363LP0222X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics, Critical Care",
            "state": "IA",
            "license": "C159713",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.