Individual provider Active NPI

Jeremy Brunner, PA-C

  • Medical Physician Assistant
  • Urbana, IL
National Provider Identifier
1982118287
Registry record updated Feb 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
085006454 Issued in IL
Practice address
1818 E Windsor Rd
Urbana, IL 61802-9566
Phone
(217) 255-9700
NPI assigned
Nov 22, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 085006454 IL Primary

Addresses

Primary practice location

1818 E Windsor Rd
Urbana, IL 61802-9566

Mailing address

611 W Park St
Urbana, IL 61801-2501

Other practice location 1

1200 W State St
Rockford, IL 61102-2112
Phone (815) 490-1600

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
I20251202001031 IL Practitioner - Physician Assistant 3577822170 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1200 W State St
Rockford, IL 61102-2112

611 W Park St
Fapc
Urbana, IL 61801-2500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085006454ILMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Carle Health Care Incorporated CurrentSince Nov 19, 2025 Accepting new patients
Crusaders Central Clinic Association Past Accepting new patients
Carle Health Care Incorporated Past Accepting new patients

Locations

1701 Curtis Rd
Champaign, IL 61822
Phone (217) 365-6201

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

1818 E Windsor Rd
Urbana, IL 61802
Phone (217) 255-9646

Organizations & group practices 3

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": "1511308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771977600000",
    "number": "1982118287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W PARK ST",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618012501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1818 E WINDSOR RD",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618029566",
            "telephone_number": "217-255-9700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1200 W State St",
            "address_purpose": "LOCATION",
            "city": "Rockford",
            "state": "IL",
            "postal_code": "611022112",
            "country_code": "US",
            "telephone_number": "815-490-1600",
            "fax_number": "815-490-1881",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRUNNER",
        "first_name": "JEREMY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-11-22",
        "last_updated": "2026-02-25",
        "certification_date": "2026-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085006454",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Urbana, IL

Sources for this page

Verify at the official NPI Registry.