Inner Wellness of Central Illinois PLLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

INNER WELLNESS OF CENTRAL ILLINOIS PLLC

Practice address

2511 N Main St
East Peoria, IL 61611

Phone

(309) 670-0459

Fax

(309) 670-0416

NPI assigned

Jul 6, 2021

Last updated

Aug 13, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jennifer Christine Alexander, APNNPI 1992233977

Title

Medical Director

Phone

(309) 670-0459

Specialties & licenses 4

Addresses

Other identifiers 3

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jennifer Christine Alexander, APN, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • East Peoria, IL
  • NPI 1992233977
  Medicare reassignment NPD Authorized official
• Lindsay Ryan Harms, M.S., L.C.P.C.

  • Professional Counselor
  • East Peoria, IL
  • NPI 1205098480
  Medicare reassignment NPD
• Jasmine Jones, MA, LCPC, NCC

  • Counselor
  • East Peoria, IL
  • NPI 1205470168

  Addiction (Substance Use Disorder)

  Medicare reassignment NPD
• Jerri Jean Genovese, MSW, LCSW, CADC

  • Clinical Social Worker
  • East Peoria, IL
  • NPI 1376103259
  NPD

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

{
    "created_epoch": "1625529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628812800000",
    "number": "1871164442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2511 N MAIN ST",
            "city": "EAST PEORIA",
            "state": "IL",
            "postal_code": "61611",
            "telephone_number": "309-670-0459",
            "fax_number": "309-670-0416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2511 N MAIN ST",
            "city": "EAST PEORIA",
            "state": "IL",
            "postal_code": "61611",
            "telephone_number": "309-670-0459",
            "fax_number": "309-670-0416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNER WELLNESS OF CENTRAL ILLINOIS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-06",
        "last_updated": "2021-08-13",
        "certification_date": "2021-08-13",
        "status": "A",
        "authorized_official_last_name": "ALEXANDER",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "CHRISTINE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "309-670-0459",
        "authorized_official_credential": "APN"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1205098480",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1205470168",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1992233977",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "officeadmin@innerwellnessil.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "jalexander@innerwellnessil.com",
            "address_1": "2511 N Main St",
            "city": "East Peoria",
            "state": "IL",
            "country_code": "US",
            "postal_code": "616111783",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Thomas Jacobs, PHARMD
• Christopher Jacobsen
• Naziya Jaffer, PHARMD

• Psychiatric/Mental Health Nurse Practitioner in East Peoria, IL
• Providers in East Peoria, 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, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.