Katelyn Sue Phillips, DNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209027803 Issued in IL

Practice address

903 S State St
Jerseyville, IL 62052-2344

Phone

(618) 639-9255

Fax

(618) 639-8100

NPI assigned

Feb 22, 2022

Last updated

Nov 13, 2024By the provider in NPPES

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

Other names 1

• Katelyn Sue Shaw Former name

Electronic endpoints 1

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

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jersey Community HospitalGroup PAC ID 4587650445, 62 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Jersey Community Hospital Hospital, Jerseyville, IL, CCN 140059

Merit-based Incentive Payment System (MIPS)

Final score

91.05 of 100Reported as apm

Quality

72.1

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/f4be81d1-a15e-4e19-9601-5214010ddaac/
• FHIR API: https://fhir-usa.unify.chbase.com/org/jersey-f23a6357
• Direct secure messaging: kphillips@jch.cernerdirect.com

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.

• Jersey Community Hospital

  • Personal Emergency Response Attendant
  • Jerseyville, IL
  • NPI 1780609925
  Medicare reassignment Care Compare group NPD
• Jersey Community Hospital

  • General Acute Care Hospital
  • Jerseyville, IL
  • NPI 1184630519
  NPD
• Jersey Community Hospital

  • Rural Health Clinic/Center
  • Jerseyville, IL
  • NPI 1700423696
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Jersey Community Hospital

  • General Acute Care Hospital
  • Jerseyville, IL
  • NPI 1184630519
  Care Compare affiliation

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

{
    "created_epoch": "1645488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731456000000",
    "number": "1891441515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "390 MAPLE SUMMIT RD",
            "city": "JERSEYVILLE",
            "state": "IL",
            "postal_code": "620522000",
            "telephone_number": "618-498-7518",
            "fax_number": "618-498-3052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 S STATE ST",
            "city": "JERSEYVILLE",
            "state": "IL",
            "postal_code": "620522344",
            "telephone_number": "618-639-9255",
            "fax_number": "618-639-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "KATELYN",
        "middle_name": "SUE",
        "credential": "DNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-22",
        "last_updated": "2024-11-13",
        "certification_date": "2024-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209027803",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kphillips@jch.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "HIE JERSEY",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "903 S State St",
            "city": "Jerseyville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "620522344",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KATELYN",
            "last_name": "SHAW",
            "middle_name": "SUE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• John L Palcheff, DO
• Leslie Palos
• Sherrie E Pearse, BEHAVIOR TECHNICIAN
• Petersen Health Network, LLC (Willow Rose Rehabilitation & Health Care)
• Phillips Investment, LLC - Jerseyville Operation Series
• Mannica Pierre
• Regina Plummer, LCSW
• Radiant Chiropractic and Natural Health LLC
• Ryan Rauscher
• Larry Duane Rawlings, C.R.N.A.

• Family Nurse Practitioner in Jerseyville, IL
• Providers in Jerseyville, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2024; 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.