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JESSICA BOUDREAU
NPI 1023780673
Dietitian, Registered in Bourbonnais, IL

Active since October 01, 2021
100 FITNESS DR, BOURBONNAIS, IL 60914(815) 936-6515 Get Directions Write a Review

NPPES record last updated: October 1, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Jessica Boudreau NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JESSICA BOUDREAU (NPI 1023780673) is an individual dietitian, registered in Bourbonnais, Illinois, licensed in Illinois (164.007714) and active in the NPI registry since October 2021.

NPPES Registry Identity

NPI1023780673
Entity TypeIndividualFemale
Primary Taxonomy133V00000X
Provider Legal NameJESSICA BOUDREAU
Location Address100 FITNESS DRBourbonnais, IL 60914-9584
Mailing Address100 Fitness DrBourbonnais, IL 60914-9584 · (815) 936-6515
Phone(815) 936-6515
Sole ProprietorYes
Enumeration DateOctober 1, 2021
NPPES CertifiedOctober 1, 2021
✔ NPI 1023780673 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDietitian, RegisteredDietary & Nutritional Service Providers
Taxonomy Code133V00000X
License✔ Licensed in IL · 164.007714
Definition
A Registered Dietitian (RD)/Registered Dietitian Nutritionist (RDN) is an individual uniquely trained in the science of nutrition and practice of dietetics to design and provide medical nutrition therapy (MNT) and other evidence-based applications of the Nutrition Care Process (NCP) that exemplify the profession's systematic approach to providing high quality nutrition care. Registered dietitians provide MNT for the purpose of disease prevention or management, or to treat or rehabilitate an illness, injury, or condition, with the use of specific, indicated physical and cognitive nutrition care services comprised of one or more of the following aspects of the NCP: nutrition assessment/reassessment, nutrition diagnosis, nutrition intervention (e.g., nutrition counseling, therapeutic diet ordering, and nutrition education) and nutrition monitoring and evaluation.
100 FITNESS DR, Bourbonnais, IL 60914
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of NC.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jessica Boudreau is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Billing Reassignment

Medicare enrollment records show Jessica Boudreau reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Riverside Medical Center
3.0 mi
Family Medicine
3400 S MAIN ST.
Hopkins Park, IL 60944
  • Reassigned Medicare billing, Illinois enrollment
  • 4 clinicians in this Medicare group
NPI 1982703005 (815) 944-5545

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 17

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JEANNE THERESE LAIRD RDN LDN
Dietitian, Registered
100 FITNESS DR
BOURBONNAIS, IL 60914
Kankakee County (815) 936-6515
SARA ELIZABETH TAN YAP MD
Internal Medicine (Endocrinology, Diabetes & Metabolism)
100 FITNESS DR
BOURBONNAIS, IL 60914
Kankakee County (815) 936-8909
AMBER KRUCHTEN
Occupational Therapy Assistant
100 FITNESS DR
BOURBONNAIS, IL 60914
Kankakee County (815) 928-6815
DR. GARY HENDERSON D.C.
Chiropractor
100 FITNESS DR
BOURBONNAIS, IL 60914
Kankakee County (815) 929-2190
DR. JABIZ BEHZADPOUR DO
Internal Medicine (Endocrinology, Diabetes & Metabolism)
100 FITNESS DR
BOURBONNAIS, IL 60914
Kankakee County (815) 936-8909
RIVERSIDE MEDICAL CENTER
Pharmacy (Community/Retail Pharmacy)
100 FITNESS DR
BOURBONNAIS, IL 60914
Kankakee County (815) 634-5225
NICOLE POTTS
Dietitian, Registered
100 FITNESS DR
BOURBONNAIS, IL 60914
Kankakee County (815) 936-6515
ISAAC CASAS RD, LDN
Dietitian, Registered
100 FITNESS DR
BOURBONNAIS, IL 60914
Kankakee County (815) 936-6515

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jessica Boudreau's NPI number?

The NPI number for Jessica Boudreau is 1023780673. It was assigned to this individual provider in the NPPES registry on October 1, 2021.

Where is Jessica Boudreau located?

Jessica Boudreau practices at 100 Fitness Dr, Bourbonnais, IL 60914. The listed phone number is (815) 936-6515.

What is Jessica Boudreau's specialty?

The primary specialty registered for this NPI is Dietitian, Registered with taxonomy code 133V00000X.

Is Jessica Boudreau enrolled in Medicare?

Yes. Jessica Boudreau is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Jessica Boudreau's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jessica Boudreau reassigns Medicare benefits to Riverside Medical Center (Hopkins Park, IL). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jessica Boudreau's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Jessica Boudreau accept?

Health plans from Blue Cross and Blue Shield of NC list Jessica Boudreau as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Jessica Boudreau was last updated on October 1, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.