Courtney Nicolle Forman, PMHNP-BC, FNP-C, FPA
NPI 1376099127ActiveIndividual· Nurse Practitioner· Rockford, IL
Nurse Practitioner (PMHNP-BC, FNP-C, FPA) in Rockford, Illinois, trained at Indiana University School of Medicine (class of 2011). Their prescriptions cost Medicare Part D more than their services did: $156,678 for 942 claims, against $18,398 paid for services in 2024. Supernus Pharmaceuticals, Inc. was the largest of 16 companies reporting payments in 2025, $20,633 in all, mostly honoraria.
Overview
| NPI | 1376099127 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PMHNP-BC, FNP-C, FPA |
| Sole proprietor | No |
| NPI issued | Aug 31, 2016 |
| Last updated in NPPES | Mar 30, 2026 |
| Certified by provider | Mar 30, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Nurse Practitioner Primary | 363L00000X | 227.004073 | IL |
| Nurse Practitioner, Psych/Mental Health | 363LP0808X | 277004073 | IL |
| Nurse Practitioner, Family | 363LF0000X | 209014910 | IL |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Nurse Practitioner (IL) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 126 |
|---|---|
| Services billed | 294 across 18 procedure codes |
| Paid by Medicare | $18,398 |
Part D prescriptions in 2024
| Prescriptions (claims) | 942 · 1,389 30-day fills |
|---|---|
| Patients | 101 |
| Total drug cost | $156,678 |
| Generic share | 87% of claims |
Education and affiliations
| Medical school | Indiana University School of Medicine |
|---|---|
| Graduation year | 2011 |
| Medicare specialty | Nurse Practitioner |
| Telehealth | Offers telehealth |
Medical groups
- Thrive Mental Wellness, PLLCPoplar Grove, IL · 4 clinicians
- Glenwood Center, LtdRockford, IL · 2 clinicians
Industry payments (Open Payments)
- 2025$20,633 · 171 payments from 16 companies
- 2024$1,377 · 63 payments from 14 companies
Top paying companies in 2025
| Company | Amount | Payments |
|---|---|---|
| Supernus Pharmaceuticals, Inc. | $18,295 | 63 |
| Otsuka America Pharmaceutical, Inc. | $470.77 | 15 |
| Axsome Therapeutics, Inc. | $294.30 | 12 |
| Abbvie Inc. | $285.28 | 16 |
| Neurocrine Biosciences, Inc. | $221.49 | 11 |
What the 2025 payments were for
- Honoraria$14,750 · 7 payments
- Food and Beverage$3,458 · 154 payments
- Travel and Lodging$2,425 · 10 payments
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
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All 134 nurse practitioners in Rockford · All nurse practitioners in Illinois