Individual provider Active NPI

Lisa M. Watson

  • Nurse Practitioner
  • Pontiac, IL
National Provider Identifier
1982797254
Registry record updated Feb 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
041217560/209002332 Issued in IL
Practice address
1506 W Reynolds St
Pontiac, IL 61764
Phone
(815) 844-6123
Fax
(815) 844-7851
NPI assigned
Oct 1, 2006
Last updated
Feb 28, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 041217560/209002332 IL Primary

Addresses

Primary practice location

1506 W Reynolds St
Pontiac, IL 61764

Mailing address

1506 W Reynolds St
Pontiac, IL 61764
Phone (815) 844-6123

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
I20070531000206 IL Practitioner - Nurse Practitioner 8022116961 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Saint James HospitalGroup PAC ID 0648187252, 74 clinicians

Practice addresses (Care Compare)

103 W S St
Osf Healthcare Medical Group Flanagan
Flanagan, IL 61740-7547
Phone (815) 796-4591

105 W Hack St
Osf Healthcare Medical Group Cullom
Cullom, IL 60929-7133
Phone (815) 689-2126

106 S 1St St
100 Osf Healthcare Medical Group Fairbury
Fairbury, IL 61739-1509
Phone (815) 692-2308

107 Watters Dr
100 Osf Healthcare Medical Group Dwight
Dwight, IL 60420-1280
Phone (815) 584-3343

1506 W Reynolds St
Osf Healthcare Medical Group Reynolds
Pontiac, IL 61764-9674
Phone (815) 844-6123

2500 W Reynolds St
Pontiac, IL 61764-9774
Phone (815) 842-2828

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
041217560/209002332ILMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Central PA Pharmacy LLC. Current Accepting new patients
Saint James Hospital CurrentSince Dec 1, 2022 Accepting new patients
Osf Multi-Specialty Group CurrentSince Jan 1, 2016 Accepting new patients
Saint James Hospital Past Accepting new patients

Locations

106 S 1st St
Fairbury, IL 61739
Phone (815) 635-3177

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

1506 W Reynolds St
Pontiac, IL 61764
Phone (815) 844-6123

2500 W Reynolds St
Pontiac, IL 61764
Phone (815) 842-2828

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1159660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1298851200000",
    "number": "1982797254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1506 W REYNOLDS ST",
            "city": "PONTIAC",
            "state": "IL",
            "postal_code": "61764",
            "telephone_number": "815-844-6123",
            "fax_number": "815-844-7851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1506 W REYNOLDS ST",
            "city": "PONTIAC",
            "state": "IL",
            "postal_code": "61764",
            "telephone_number": "815-844-6123",
            "fax_number": "815-844-7851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATSON",
        "first_name": "LISA",
        "middle_name": "M.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-01",
        "last_updated": "2011-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "041217560/209002332",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pontiac, IL

Sources for this page

Verify at the official NPI Registry.