JENNA DIVELY FNP-C
NPI 1508747387
Nurse Practitioner - Family in Canton, IL

Q: What is Jenna Dively's NPI number?

The NPI number for Jenna Dively is 1508747387. It was assigned to this individual provider in the NPPES registry on September 9, 2025.

Q: What is Jenna Dively's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Jenna Dively was last updated on September 9, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.

Active since September 09, 2025PECOS EnrolledAccepts Medicare Assignment

210 W WALNUT ST, CANTON, IL 61520(309) 647-0201 Get Directions Write a Review

NPPES record last updated: September 9, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

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About Jenna Dively Fnp-c NPPES

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

JENNA DIVELY FNP-C (NPI 1508747387) is an individual family provider in Canton, Illinois, licensed in Illinois (209.033183) and active in the NPI registry since September 2025. She is enrolled in Medicare PECOS and is a graduate of Other (2025).

NPPES Registry Identity

NPI1508747387

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameJENNA DIVELYCredential: FNP-C

Location Address210 W WALNUT STCanton, IL 61520-2497

Mailing Address1133 Woodland TrlMacomb, IL 61455-3522

Phone(309) 647-0201

Sole ProprietorNo

Medical School CMSOtherGraduated 2025

Enumeration DateSeptember 9, 2025

NPPES CertifiedSeptember 9, 2025

✔ NPI 1508747387 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in IL · 209.033183

210 W WALNUT ST, Canton, IL 61520

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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

Jenna Dively Fnp-c 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 ID1759860661

PECOS Enrollment IDI20260211000840

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 61520 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.

DELLA EETEN CRNA

Nurse Anesthetist, Certified Registered