Jodie Shipley, DNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

209027059 Issued in IL

Practice address

6805 Il 162
Suite 201
Maryville, IL 62062

Phone

(618) 288-5019

NPI assigned

Jan 27, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO, IL2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Community and Long-Term Care Psychiatry LLCGroup PAC ID 4486949773, 14 clinicians

Southern Illinois Associates LLCGroup PAC ID 2961489992, 16 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

95.86 of 100Reported as group

Quality

70.88

Promoting interoperability

100

Improvement activities

40

Cost

82.7

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jodie.shipley.1@20454.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/17590/brand/1/csg/1/fhir/r4
• FHIR API: https://fhir4.healow.com/fhir/r4/AFHDDD

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.

• Southern Illinois Associates LLC

  • Psychiatry Physician
  • Maryville, IL
  • NPI 1962427856
  Medicare reassignment Care Compare group NPD
• Community and Long-Term Care Psychiatry LLC

  • Psychiatry Physician
  • Saint Louis, MO
  • NPI 1699121475
  Medicare reassignment Care Compare group
• Psychiatric Urgent Care LLC

  • Urgent Care Clinic/Center
  • Maryville, IL
  • NPI 1134843451
  NPD

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

{
    "created_epoch": "1674777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786579200000",
    "number": "1811603376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7955 LEBANON RD",
            "city": "TROY",
            "state": "IL",
            "postal_code": "622942805",
            "telephone_number": "618-960-8991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6805 IL 162",
            "address_2": "SUITE 201",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "62062",
            "telephone_number": "618-288-5019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIPLEY",
        "first_name": "JODIE",
        "name_prefix": "Dr.",
        "credential": "DNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-27",
        "last_updated": "2026-08-13",
        "certification_date": "2026-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "209027059",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Serenity Surgery
• Charles Miguel Serrano, CRNA
• Samir K Shah, M.D.
• Jessica Lynn Sheffer, MSN, APRN, FNP-BC
• Kyle Shepperson, MD
• Holly Harlow Shirley, N.P.
• McKenna Ivy Shofroth, RN
• Lauren Kathryn Sidwell, FNP-BC
• Mark Silvey, CRNA
• James M Simmering, MD

• Psychiatric/Mental Health Nurse Practitioner in Maryville, IL
• Providers in Maryville, IL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.