Adebimpe Favour Erebholo, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

209022026 Issued in IL

Practice address

3300 N Main St
East Peoria, IL 61611-1562

Phone

(309) 698-8300

Fax

(309) 698-8303

NPI assigned

Aug 3, 2020

Last updated

Sep 17, 2020By 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 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX, 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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  IL, Nurse Practitioner

  Medicare reassignment NPD
• Vpa of Texas PLLC

  dba HarmonyCares Medical Group

  • Family Medicine Physician
  • Irving, TX
  • NPI 1679510499
  Medicare reassignment NPD
• Vpa of Texas PLLC

  dba HarmonyCares Medical Group

  • Family Medicine Physician
  • Irving, TX
  • NPI 1326667536
  NPD
• Vpa of Texas PLLC

  • Clinical Social Worker
  • San Antonio, TX
  • NPI 1578175865
  NPD

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

{
    "created_epoch": "1596412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600300800000",
    "number": "1982214144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 N MAIN ST",
            "city": "EAST PEORIA",
            "state": "IL",
            "postal_code": "616111562",
            "telephone_number": "309-698-8300",
            "fax_number": "309-698-8303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 N MAIN ST",
            "city": "EAST PEORIA",
            "state": "IL",
            "postal_code": "616111562",
            "telephone_number": "309-698-8300",
            "fax_number": "309-698-8303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EREBHOLO",
        "first_name": "ADEBIMPE",
        "middle_name": "FAVOUR",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-03",
        "last_updated": "2020-09-17",
        "certification_date": "2020-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209022026",
            "primary": true
        },
        {
            "code": "163WN0300X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Nephrology",
            "state": "IL",
            "license": "041434445",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "adebimpe.erebholo@fmc-na.com",
            "affiliation": "N",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Dialysis Unit",
            "address_1": "3300 N Main St",
            "city": "East Peoria",
            "state": "IL",
            "country_code": "US",
            "postal_code": "616111562",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• East Peoria Gardens Healthcare
• East Peoria NH LLC (River Crossing of East Peoria)
• East Peoria Walk-in Chiropractic LLC
• Nancy S. Egger, L.C.S.W.
• Hilary Enzweiler
• Freddy A Escorcia, M.D.
• Everside Health, LLC
• Abby Christine Fancher, CCC-SLP
• Julie Ann Feeny, PT
• Elyse Nicole Feinhals, CCLS

• Nurse Practitioner in East Peoria, IL
• Providers in East Peoria, IL by specialty
• Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.