CMS-1500 Box 24J / 33a • NPI
1487075305
Type 1 Individual Rendering/Ordering
HIPAA NUCC Taxonomy • CMS Code
363LP0200X (CMS 50)
Board-Certified Pediatrician (Infant, Child & Adolescent Medicine)
Box 32 Service Location & ZIP+4
100 W 15TH ST, BEARDSTOWN, IL, 62618-1774
✓ 9-Digit EDI 837 ZIP+4 (62618-1774)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1487075305 (COURTNEY BROOKE ELLIOTT, RN, CPNP) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1487075305 (NPI-1 Individual Practitioner) |
|---|---|
| Provider / Legal Name | COURTNEY BROOKE ELLIOTT, RN, CPNP |
| Plain-English Specialty | Board-Certified Pediatrician (Infant, Child & Adolescent Medicine) NUCC Code: 363LP0200X (Nurse Practitioner, Pediatrics) |
| Certifying / Licensing Body | American Board of Pediatrics (ABP) |
| Practice Location Address | 100 W 15TH ST, BEARDSTOWN, IL, 62618-1774 |
| Practice Telephone / Fax | Tel: (217) 323-2245 | Fax: (217) 323-2684 |
| Administrative Mailing Address | 100 W 15TH ST, BEARDSTOWN, IL, 62618-1774 |
| Enumeration & Last Sync | Enumerated: 2013-12-18 | CMS Record Updated: 2015-06-30 |
Clinic Location, Accessibility & Directions
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Plain-English Taxonomy & CMS Crosswalk (363LP0200X)
What Does Taxonomy Code 363LP0200X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363LP0200X translates to:
"Board-Certified Pediatrician (Infant, Child & Adolescent Medicine)"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (COURTNEY BROOKE ELLIOTT, RN, CPNP)
Typical CPT / Diagnostic Procedures:- Comprehensive Well-Child Developmental & Growth Visits (CPT 99381–99394)
- Childhood Immunization Administration (Rotavirus, MMR, DTaP, HPV, PCV)
- Neonatal Bilirubin & Jaundice Transcutaneous/Serum Screening
- Rapid Streptococcal, RSV & Influenza Point-of-Care Diagnostics
- Pediatric Asthma Nebulization & Spirometry Evaluation
- Amoxicillin / Amoxicillin-Clavulanate (Pediatric Otitis Media & Sinusitis)
- WHO Low-Osmolarity Oral Rehydration Salts (ORS) & Zinc Sulfate
- Albuterol Sulfate Inhalers & Fluticasone Pediatric Inhalers
- Weight-Based Acetaminophen & Ibuprofen Antipyretic Suspensions
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
363LP0200X — Nurse Practitioner, PediatricsPlain English: Board-Certified Pediatrician (Infant, Child & Adolescent Medicine) | State: TN | License: 18596 | Primary: Secondary |
163WP0200X — Registered Nurse, PediatricsPlain English: Board-Certified Pediatrician (Infant, Child & Adolescent Medicine) | State: TN | License: 199590 | Primary: Secondary |
163WP0200X — Registered Nurse, PediatricsPlain English: Board-Certified Pediatrician (Infant, Child & Adolescent Medicine) | State: IL | License: 041.430842 | Primary: Secondary |
363LP0200X — Nurse Practitioner, PediatricsPlain English: Board-Certified Pediatrician (Infant, Child & Adolescent Medicine) | State: IL | License: 209.012897 | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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