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JACQUELINE WUDTKE
NPI 1780535872
Nurse Practitioner - Acute Care in Peoria, IL

Active since February 05, 2026PECOS Enrolled
530 NE GLEN OAK AVE, PEORIA, IL 61637(309) 655-2000 Get Directions Write a Review

NPPES record last updated: February 5, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Jacqueline Wudtke NPPES

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

JACQUELINE WUDTKE (NPI 1780535872) is an individual acute care provider in Peoria, Illinois, licensed in Illinois (209033941) and active in the NPI registry since February 2026. She is enrolled in Medicare PECOS and is a graduate of Other (2025).

NPPES Registry Identity

NPI1780535872
Entity TypeIndividualFemale
Primary Taxonomy363LA2100X
Provider Legal NameJACQUELINE WUDTKE
Location Address530 NE GLEN OAK AVEPeoria, IL 61637-0001
Mailing Address320 Miller AveChampaign, IL 61821-2444
Phone(309) 655-2000
Sole ProprietorNo
Medical School CMSOtherGraduated 2025
Enumeration DateFebruary 5, 2026
NPPES CertifiedFebruary 5, 2026
✔ NPI 1780535872 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Acute CarePhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LA2100X
License✔ Licensed in IL · 209033941
530 NE GLEN OAK AVE, Peoria, IL 61637
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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 (PECOS)

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

PECOS PAC ID6002386307
PECOS Enrollment IDI20260528001116
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 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. DEEPAK S NAIR M.D.
Psychiatry & Neurology (Neurology)
530 NE GLEN OAK AVE
PEORIA, IL 61637
Peoria County (309) 655-2000
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

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 Jacqueline Wudtke's NPI number?

The NPI number for Jacqueline Wudtke is 1780535872. It was assigned to this individual provider in the NPPES registry on February 5, 2026.

Where is Jacqueline Wudtke located?

Jacqueline Wudtke practices at 530 NE Glen Oak Ave, Peoria, IL 61637. The listed phone number is (309) 655-2000.

What is Jacqueline Wudtke's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Acute Care, with taxonomy code 363LA2100X.

Is Jacqueline Wudtke enrolled in Medicare?

Yes. Jacqueline Wudtke is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jacqueline Wudtke was last updated on February 5, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.