JORDAN KELLY MANDEVILLE – Psychiatric/Mental Health Nurse Practitioner, NPI 1972387504
Psychiatric/Mental Health Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
11,632 NURSE PRACTITIONER in IL
Provider Addresses for JORDAN KELLY MANDEVILLE
61 BOURBAKI RD
NEW BERLIN, IL 626704570
Phone: (217) 801-8732
Type: Mailing
1020 S 5TH ST
SPRINGFIELD, IL 627032312
Phone: (217) 544-3143
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 2 Open Payments records for all available years, with a total value of $39.
Total Amount is formed as General ($39) + Research ($0) + Ownership ($0) = $39.
Last reported payment date: 2024-03-06 • Largest payer in this snapshot: ABBVIE INC. ($24).
Total Amount
$39
General + Research + Ownership
Payments
2
Total payment records
General Amount
$39
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-03-06
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ABBVIE INC. | $24 |
| Lundbeck LLC | $14 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2024-07-31
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20240731000034 | I | Nurse Practitioner | IL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 62670)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | IL | |
| Clinical Social Worker | IL | |
| - | IL | |
| Mental Health Counselor | IL | |
| Mental Health Counselor | IL | |
| Mental Health Counselor | IL | |
| P S Y C H I A T R Y | IL | |
| Clinical Social Worker | IL |
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