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TONI SUE BALDWIN-DUFOUR APRN
NPI 1255343349
Nurse Practitioner - Family in Swansea, IL

Active since August 13, 2006PECOS EnrolledAccepts Medicare Assignment
77.19/100
CMS Quality Rating
4000 N ILLINOIS LN, SWANSEA, IL 62226(618) 257-6380(618) 257-6444 Get Directions Write a Review

NPPES record last updated: September 18, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Sep 18, 2025, Apr 10, 2025, Aug 12, 2019 and 2 more (5 updates tracked since 2018).

About Toni Sue Baldwin-dufour Aprn NPPES

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

TONI SUE BALDWIN-DUFOUR APRN (NPI 1255343349) is an individual family provider in Swansea, Illinois, licensed in Florida (APRN9318582) and active in the NPI registry since August 2006. She is enrolled in Medicare PECOS, maintains a secondary practice location in Gainesville, and is a graduate of Other (2010).

NPPES Registry Identity

NPI1255343349
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameTONI SUE BALDWIN-DUFOURCredential: APRN
Location Address4000 N ILLINOIS LNSwansea, IL 62226-1969
Mailing AddressPo Box 959203Saint Louis, MO 63195-9203 · (618) 257-6380 · Fax (618) 257-6444
Phone(618) 257-6380
Fax(618) 257-6444
Sole ProprietorNo
Medical School CMSOtherGraduated 2010
Enumeration DateAugust 13, 2006
Last NPPES UpdateSeptember 18, 20255 updates tracked since enumeration
NPPES CertifiedSeptember 18, 2025
✔ NPI 1255343349 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
Licenses✔ Licensed in FL · APRN9318582✔ Licensed in FL · ARNP9318582
Also ListedNurse PractitionerTaxonomy 363L00000X · License 2090280069 (IL)
4000 N ILLINOIS LN, Swansea, IL 62226
Open in Google Maps ↗

Secondary Practice Location 1

Location 14343 W Newberry RdGainesville, FL 32607-2817 · Phone (352) 416-1082 · Fax (352) 373-6144

Other Identifiers 1

Medicaid009087200FL

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include AvMed, Wellpoint.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Toni Sue Baldwin-dufour Aprn is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8820194509
PECOS Enrollment IDI20240109001180
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 9

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
60 services51 patients
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204
This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.
56 services56 patients
Detection test by immunoassay with direct visual observation for influenza virus 87804
This is a test that identifies the influenza virus in your body. It works by using an immunoassay, a method that detects the presence of the virus through an immune response. The results are directly observable, making it a quick and efficient way to diagnose flu.
44 services22 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
32 services32 patients
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203
This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.
28 services28 patients
Automated urinalysis test 81003
An automated urinalysis test is a routine examination that checks your urine for various substances. It can help identify potential health issues such as kidney problems or diabetes. The test uses a machine to analyze a small urine sample, providing quick and accurate results.
25 services22 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 62226 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$88.44 typical visit price
range $56.28 – $173.35
Typical copayment $22.11 (range $14.07 – $43.33)
Most-billed visit code 99203
Established Patient
$99.71 typical visit price
range $17.51 – $139.99
Typical copayment $24.92 (range $4.37 – $34.99)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

77.19/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality57.57
Promoting Interoperability87
Improvement Activities40
Cost77.24

Referred Medical Equipment & Supplies CMS DME claims 11

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
6 suppliers25 claims60 services$5.94 avg. paid by Medicare
Lancets, per box of 100 A4259
DME-Medical/Surgical Supplies · category DA000N
6 suppliers17 claims22 services$1.13 avg. paid by Medicare
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable A7003
DME-Other DME · category DE000N
1 supplier11 claims21 services$1.42 avg. paid by Medicare
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress E0260
DME-Hospital Beds · category DB000N
1 supplier12 claims12 services$55.48 avg. paid by Medicare
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing E0431
DME-Oxygen and Supplies · category DC000N
1 supplier13 claims13 services$17.62 avg. paid by Medicare
Nebulizer, with compressor E0570
DME-Other DME · category DE000N
3 suppliers20 claims20 services$5.87 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 4

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

FAZILLAH FAIZ PA-C
Physician Assistant
4000 N ILLINOIS LN
SWANSEA, IL 62226
St. Clair County (618) 257-6380
DR. SAMUEL A. BURSTEIN M.D.
Internal Medicine (Hematology & Oncology)
4000 N ILLINOIS LN, SUITE C
SWANSEA, IL 62226
St. Clair County (618) 233-8000
LAUREN ECK FNP
Nurse Practitioner (Family)
4000 N ILLINOIS LN
SWANSEA, IL 62226
St. Clair County (618) 236-1000
LABORATORY CORPORATION OF AMERICA
Clinical Medical Laboratory
4000 N ILLINOIS LN, STE D
SWANSEA, IL 62226
St. Clair County (618) 233-8505

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 Toni Baldwin-dufour's NPI number?

The NPI number for Toni Baldwin-dufour is 1255343349. It was assigned to this individual provider in the NPPES registry on August 13, 2006.

Where is Toni Baldwin-dufour located?

Toni Baldwin-dufour practices at 4000 N Illinois Ln, Swansea, IL 62226. The listed phone number is (618) 257-6380.

What is Toni Baldwin-dufour's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Toni Baldwin-dufour enrolled in Medicare?

Yes. Toni Baldwin-dufour is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Toni Baldwin-dufour accept?

Health plans from AvMed and Wellpoint list Toni Baldwin-dufour 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 Toni Baldwin-dufour was last updated on September 18, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months 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.