Individual provider Active NPI

Jennifer Lynn Runyon, MSN, APN

  • Adult Health Clinical Nurse Specialist
  • Peoria, IL
National Provider Identifier
1972732246
Registry record updated Oct 22, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Clinical Nurse SpecialistTaxonomy code 364SA2200X
License
209007635 Issued in IL
Practice address
530 NE Glen Oak Ave
Peoria, IL 61603-3133
Phone
(309) 655-2000
NPI assigned
Jul 8, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Clinical Nurse Specialist 364SA2200X 209007635 IL Primary

Addresses

Primary practice location

530 NE Glen Oak Ave
Peoria, IL 61603-3133

Mailing address

530 NE Glen Oak Ave
Peoria, IL 61603-3133
Phone (309) 655-2000

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
I20121011000203 IL Practitioner - Nurse Practitioner 7012166861 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2008
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)

8600 State Route 91
Suite 130
Peoria, IL 61615-7829
Phone (309) 683-5050

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
209007635ILMDAdult Health Clinical Nurse Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Methodist Medical Center of Illinois CurrentSince Aug 1, 2017 Accepting new patients
Methodist Medical Center of Illinois CurrentSince Aug 1, 2017 Accepting new patients
Osf Multi-Specialty Group CurrentSince Dec 21, 2021 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients

Locations

695 N Kellogg St
Galesburg, IL 61401
Phone (309) 343-8131

221 NE Glen Oak Ave
Peoria, IL 61636
Phone (309) 672-4281

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

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

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

120 NE Glen Oak Ave
Ste 400
Peoria, IL 61603
Phone (309) 671-3519

8940 N Wood Sage Rd
Peoria, IL 61615
Phone (309) 243-3610

Organizations & group practices 4

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": "1247011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350864000000",
    "number": "1972732246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616033133",
            "telephone_number": "309-655-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616033133",
            "telephone_number": "309-655-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUNYON",
        "first_name": "JENNIFER",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "MSN, APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-08",
        "last_updated": "2012-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SA2200X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Adult Health",
            "state": "IL",
            "license": "209007635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.