Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

JORDAN KELLY MANDEVILLE
NPI 1972387504
Nurse Practitioner - Psychiatric/Mental Health in Springfield, IL

Q: What is Jordan Mandeville's NPI number?

The NPI number for Jordan Mandeville is 1972387504. It was assigned to this individual provider in the NPPES registry on August 23, 2023.

Q: What is Jordan Mandeville's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Q: When was this NPI record last updated?

The NPPES record for Jordan Mandeville was last updated on June 26, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 51 days 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 August 23, 2023PECOS EnrolledAccepts Medicare Assignment

3901 PINTAIL DR STE A, SPRINGFIELD, IL 62711(217) 544-3143(217) 544-4436 Get Directions Write a Review

NPPES record last updated: June 26, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

On this page

About Jordan Kelly Mandeville NPPES

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

JORDAN KELLY MANDEVILLE (NPI 1972387504) is an individual psychiatric/mental health provider in Springfield, Illinois, licensed in Illinois (209028150) and active in the NPI registry since August 2023. She is enrolled in Medicare PECOS and is a graduate of Other (2023).

NPPES Registry Identity

NPI1972387504

Entity TypeIndividualFemale

Primary Taxonomy363LP0808X

Provider Legal NameJORDAN KELLY MANDEVILLE

Location Address3901 PINTAIL DR STE ASpringfield, IL 62711-6768

Mailing Address61 Bourbaki RdNew Berlin, IL 62670-4570 · (217) 801-8732

Phone(217) 544-3143

Fax(217) 544-4436

Sole ProprietorNo

Medical School CMSOtherGraduated 2023

Enumeration DateAugust 23, 2023

Last NPPES UpdateJune 26, 2026

NPPES CertifiedJune 26, 2026

✔ NPI 1972387504 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP0808X

License✔ Licensed in IL · 209028150

3901 PINTAIL DR STE A, Springfield, IL 62711

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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

Jordan Kelly Mandeville 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 ID8921545641

PECOS Enrollment IDI20240731000034

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 62711 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 4

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

PATRICIA JEAN FOLLIN LCPC

Counselor (Professional)

3901 PINTAIL DR STE A
SPRINGFIELD, IL 62711

Sangamon County (217) 544-3143

DR. TERRY M KILLIAN MD

Psychiatry & Neurology (Psychiatry)

3901 PINTAIL DR STE A
SPRINGFIELD, IL 62711

Sangamon County (217) 544-3143

KARMA LYNN CARPENTER LCSW

Social Worker (Clinical)

3901 PINTAIL DR STE A
SPRINGFIELD, IL 62711

Sangamon County (217) 544-3143

KILLIAN AND ASSOCIATES SC

Psychiatry & Neurology (Psychiatry)

3901 PINTAIL DR STE A
SPRINGFIELD, IL 62711

Sangamon County (217) 544-3143

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 Jordan Mandeville's NPI number?

The NPI number for Jordan Mandeville is 1972387504. It was assigned to this individual provider in the NPPES registry on August 23, 2023.

Where is Jordan Mandeville located?

Jordan Mandeville practices at 3901 Pintail Dr Ste A, Springfield, IL 62711. The listed phone number is (217) 544-3143.

What is Jordan Mandeville's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Is Jordan Mandeville enrolled in Medicare?

Yes. Jordan Mandeville 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.

When was this NPI record last updated?

The NPPES record for Jordan Mandeville was last updated on June 26, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 51 days 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.