Nicole Gabriel Tenegra, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036-153194 Issued in IL

Practice address

102 W Kenwood Ave
Decatur, IL 62526-4368

Phone

(217) 872-3800

Fax

(217) 872-0849

NPI assigned

Jun 7, 2017

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 IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians

Board of Trustees of Southern Illinois UniversityGroup PAC ID 4486667888, 139 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Hospice Care of Illinois Hospice, Springfield, IL, CCN 141540
• Decatur Memorial Hospital Hospital, Decatur, IL, CCN 140135

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nicoletenegra@siusm.allscriptsdirect.net

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.

• Board of Trustees of Southern Illinois University

  • Primary Care Clinic/Center
  • Springfield, IL
  • NPI 1396097960

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Board of Trustees of Southern Illinois University

  • Rural Health Clinic/Center
  • Carbondale, IL
  • NPI 1215978127
  NPD
• Board of Trustees of Southern Illinois University

  • Federally Qualified Health Center (FQHC)
  • Springfield, IL
  • NPI 1558848473
  NPD
• Board of Trustees of Southern Illinois University

  • Federally Qualified Health Center (FQHC)
  • Carbondale, IL
  • NPI 1568210425
  NPD
• Board of Trustees of Southern Illinois University

  • Federally Qualified Health Center (FQHC)
  • Decatur, IL
  • NPI 1407376338
  NPD (past)
• Southern Illinois University

  • Clinic/Center
  • E Saint Louis, IL
  • NPI 1306273776
  NPD (past)

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

• Decatur Memorial Hospital

  • General Acute Care Hospital
  • Decatur, IL
  • NPI 1548357973
  Care Compare affiliation
• Memorial Home Services

  • Community Based Hospice Care Agency
  • Springfield, IL
  • NPI 1003935560
  Care Compare affiliation

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

{
    "created_epoch": "1496793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607299200000",
    "number": "1992234504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19644",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627949644",
            "telephone_number": "217-545-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 W KENWOOD AVE",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625264368",
            "telephone_number": "217-872-3800",
            "fax_number": "217-872-0849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TENEGRA",
        "first_name": "NICOLE",
        "middle_name": "GABRIEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-07",
        "last_updated": "2020-12-07",
        "certification_date": "2020-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "125070186",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-153194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nicoletenegra@siusm.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "102 W Kenwood Ave",
            "city": "Decatur",
            "state": "IL",
            "country_code": "US",
            "postal_code": "625264368",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Aniyiah Taylor
• Keli K Taylor, RN
• Joanna E Tedford
• Ruth Elizabeth Teel, LCPC
• Johnny C Tenegra, M.D.
• William Smythe Tener, D.D.S.,M.S.
• Meridith Teodoro, RBT
• Floyd W Terry, QMHP
• Destiny Tertocha
• Ashley Thais, PHARMD

• Family Medicine Physician in Decatur, IL
• Providers in Decatur, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 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.
• 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.