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MR. JESSE LEE HENNEBERG APN
NPI 1316299456
Nurse Practitioner - Neonatal in Peoria, IL

Active since October 14, 2012PECOS Enrolled
530 NE GLEN OAK AVE, PEORIA, IL 61637(309) 624-0629 Get Directions Write a Review

NPPES record last updated: July 19, 2021. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Mr. Jesse Lee Henneberg Apn NPPES

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

MR. JESSE LEE HENNEBERG APN (NPI 1316299456) is an individual neonatal provider in Peoria, Illinois, licensed in Illinois (209009916) and active in the NPI registry since October 2012. He is enrolled in Medicare PECOS and maintains a secondary practice location in Springfield.

NPPES Registry Identity

NPI1316299456
Entity TypeIndividualMale
Primary Taxonomy363LN0000X
Provider Legal NameMR. JESSE LEE HENNEBERGCredential: APN
Location Address530 NE GLEN OAK AVEPeoria, IL 61637-0001
Mailing Address201 E Madison St Ste 328Springfield, IL 62702-5131 · (217) 545-7731
Phone(309) 624-0629
Sole ProprietorYes
Enumeration DateOctober 14, 2012
Last NPPES UpdateJuly 19, 2021
NPPES CertifiedJuly 19, 2021
✔ NPI 1316299456 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · NeonatalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LN0000X
License✔ Licensed in IL · 209009916
Also ListedNurse Practitioner · Neonatal, Critical CareTaxonomy 363LN0005X · License 209009916 (IL)
530 NE GLEN OAK AVE, Peoria, IL 61637
Open in Google Maps ↗

Secondary Practice Location 1

Location 1415 N 9th St Ste 4W16Springfield, IL 62702-5303 · Phone (217) 545-8000

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Jesse Lee Henneberg Apn is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

Medicare Billing Reassignments

2

Medicare enrollment records show Jesse Henneberg reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Osf Multi-Specialty Group
7.4 mi
Internal Medicine
8600 N STATE ROUTE 91
Peoria, IL 61615
  • Reassigned Medicare billing, Illinois enrollment
  • 2,944 clinicians in this Medicare group
NPI 1922445527 (309) 683-5050
Siu Physicians & Surgeons, Inc
62 mi
Endocrinology, Diabetes & Metabolism
201 E MADISON ST STE 328
Springfield, IL 62702
  • Reassigned Medicare billing, Illinois enrollment
  • 645 clinicians in this Medicare group
NPI 1558385989 (217) 545-8000

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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 61637 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
$85.71 typical visit price
range $54.80 – $168.44
Typical copayment $21.42 (range $13.70 – $42.11)
Most-billed visit code 99203
Established Patient
$97.25 typical visit price
range $17.16 – $136.56
Typical copayment $24.31 (range $4.29 – $34.14)
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.

Other Providers at the Same Location NPPES 20

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

DR. HAMID MAHMOOD ZIA M.D
Pathology (Anatomic Pathology & Clinical Pathology)
530 NE GLEN OAK AVE, CENTRAL ILLINOIS PATHOLOGY SC
PEORIA, IL 61637
Peoria County (309) 624-9011
THOMAS JAMES MCMORROW MD
Pediatrics
530 NE GLEN OAK AVE
PEORIA, IL 61637
Peoria County (309) 655-2553
ALEXANDRA ROPER MD
Surgery
530 NE GLEN OAK AVE
PEORIA, IL 61637
Peoria County (309) 655-2000
JAPMEHR KAUR SANDHU M.B.B.S.
Student in an Organized Health Care Education/Training Program
530 NE GLEN OAK AVE
PEORIA, IL 61637
Peoria County (309) 624-9351
THOMAS BLACKWELL JR. MD
Student in an Organized Health Care Education/Training Program
530 NE GLEN OAK AVE
PEORIA, IL 61637
Peoria County (309) 655-2000
LUKE KLOFT
Student in an Organized Health Care Education/Training Program
530 NE GLEN OAK AVE
PEORIA, IL 61637
Peoria County (309) 655-2109
ABIGAIL V. WELU DO
Student in an Organized Health Care Education/Training Program
530 NE GLEN OAK AVE
PEORIA, IL 61637
Peoria County (309) 655-6710
DR. JAMES DANIEL DEWAR D.O.
Internal Medicine (Interventional Cardiology)
530 NE GLEN OAK AVE
PEORIA, IL 61637
Peoria County (309) 655-7257

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 Jesse Henneberg's NPI number?

The NPI number for Jesse Henneberg is 1316299456. It was assigned to this individual provider in the NPPES registry on October 14, 2012.

Where is Jesse Henneberg located?

Jesse Henneberg practices at 530 NE Glen Oak Ave, Peoria, IL 61637. The listed phone number is (309) 624-0629.

What is Jesse Henneberg's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Neonatal, with taxonomy code 363LN0000X.

Is Jesse Henneberg enrolled in Medicare?

Yes. Jesse Henneberg is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Jesse Henneberg's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jesse Henneberg reassigns Medicare benefits to 2 organizations: Osf Multi-Specialty Group (Peoria, IL) and Siu Physicians & Surgeons, Inc (Springfield, IL). Each 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 Jesse Henneberg's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Jesse Henneberg was last updated on July 19, 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.