ILLINOIS CARDIAC SURGERY ASSOCIATES SC (NPI# 1114018439) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114018439 |
| Entity Type | Organization |
| Organization Name | ILLINOIS CARDIAC SURGERY ASSOCIATES SC |
| Practice Address |
515 Ne Glen Oak Suite 105 Peoria IL 61603-3167 |
| Practice Telephone | 3096742002 |
| Practice Fax Number | 3096249898 |
| Mailing Telephone | 3096742002 |
| Mailing Fax Number | 3096249898 |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2014-05-06 |
| Authorized Official Name | MR. DALE M GEISS (PRESIDENT) |
| Authorized Official Telephone | 3096742002 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BLUE SHEILD | 07215075 | 01 |
| Street Address |
515 NE GLEN OAK SUITE 105 |
| City | PEORIA |
| State | IL |
| Zip Code | 61603-3167 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912970617 | Dale M Geiss | Surgery | 515 Ne Glen Oak, Suite 105, Peoria, IL 61603-3167 | 2006-02-12 |
| 1144479981 | Diane Marie Cass | Social Worker | 515 Ne Glen Oak, Peoria, IL 61637-0001 | 2008-09-17 |
| 1447430616 | Angela D Brown | Nurse Practitioner | 515 Ne Glen Oak, Suite 105, Peoria, IL 61603-3167 | 2007-11-06 |
| 1003990839 | Sheri K Buskirk | Registered Nurse | 515 Ne Glen Oak, Suite 105, Peoria, IL 61603-3167 | 2006-10-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598362980 | Courtney Klein | Nurse Practitioner | 1306 N. Berkley Ave, Peoria, IL 61603 | 2020-10-08 |
| 1114588217 | Kong Xing Wang | Dentist | 320 East Armstrong Ave, Peoria, IL 61603 | 2019-06-28 |
| 1073015319 | Sara Kristine Rosenbery | Nurse Practitioner | 515 Ne Glen Oak Ave Ste 202, Peoria, IL 61603 | 2018-03-02 |
| 1861860058 | Jennifer Michelle Kelsey | Clinical Nurse Specialist | 420 Ne Glen Oak Avenue, Suite 401, Peoria, IL 61603 | 2015-09-04 |
| 1467859793 | Bonnie Lansing | Counselor | 617 N Gendale Avenue, Behavioral Health Adult Program, Peoria, IL 61603 | 2014-12-02 |
| 1639597172 | Jael K. Mahasi | Counselor | 1800 Ne Perry Avenue, Peoria, IL 61603 | 2014-04-02 |
| 1992054829 | Justin S Ferragut | Radiology | 530 Northeast Glen Oak Avenue, Peoria, IL 61603 | 2012-09-06 |
| 1780952994 | Syed Muhammad Tayyab | Internal Medicine | 828 Ne Glen Oak Ave Apt No208a, Peoria, IL 61603 | 2011-12-02 |
| 1528389079 | St. Francis Medical Center | General Acute Care Hospital | 530 N E Glen Oak Ave, Peoria, IL 61603 | 2010-06-18 |
| 1780810648 | Children's Home Association of Illinois | Voluntary or Charitable | 400 E. Frye, Peoria, IL 61603 | 2009-06-05 |
| Find all providers in zip 61603 | ||||
| Taxonomy Code | 208G00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
| A thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Thoracic Surgery, 2007. http://www.abts.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Thoracic Surgery. Thoracic surgeons have the knowledge, experience and technical skills to accurately diagnose, operate upon safely, and effectively manage patients with thoracic diseases of the chest. This requires substantial knowledge of cardiorespiratory physiology and oncology, as well as capability in the use of heart assist devices, management of abnormal heart rhythms and drainage of the chest cavity, respiratory support systems, endoscopy and invasive and noninvasive diagnostic techniques. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518991074 | Mark D Plunkett | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 420 Ne Glen Oak Ave Ste 301, Suite 301, Peoria, IL 61603-3169 | 2006-07-10 |
| 1720023179 | Heartcare Midwest, Ltd | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 5405 N Knoxville Avenue, Peoria, IL 61614-5016 | 2006-06-19 |
| 1154337236 | Paul A Siebert | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1001 Main St, Suite 300, Peoria, IL 61606-1907 | 2006-07-31 |
| 1487669735 | Farnaz Nani Moazzam | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1001 Main St, Suite 300, Peoria, IL 61606-1907 | 2006-07-29 |
| 1992735922 | James Munns | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 5405 N Knoxville Ave, Peoria, IL 61614-5016 | 2006-07-04 |
| 1396780292 | Siebert Moazzam P C | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 401 Main Street, Suite 1200, Peoria, IL 61602-1242 | 2006-06-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205363041 | Sachowdhry | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1 S Summit Ave, Oakbrook Terrace, IL 60181-2212 | 2017-05-11 |
| 1760930028 | Hiroto Kitahara | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 5841 S. Maryland Avenue M/c6040, Chicago, IL 60637 | 2016-09-15 |
| 1720440282 | Azad Karim | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 441 E Erie St Apt 1803441, Chicago, IL 60611-4446 | 2016-03-24 |
| 1982002838 | Milton Weinberg Jr. | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 983 Kirkhill Ln, Lake Forest, IL 60045-4209 | 2014-12-09 |
| 1235557190 | Bartlomiej Imielski | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 201 E. Huron St., Galter 11-140, Chicago, IL 60611 | 2014-03-28 |
| 1841635869 | Aaron Maxwell Kime | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 133 E Brush Hill Rd Ste 200, Elmhurst, IL 60126-5661 | 2013-05-03 |
| 1952744823 | Walter Lee Barker | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2912 N. Commonwealth Ave., #11c, Chicago, IL 60657-6235 | 2013-04-10 |
| 1952641649 | Willard A Fry | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1500 Sheridan Rd, #10e, Wilmette, IL 60091-1873 | 2013-02-18 |
| 1487903092 | Horizons In Healthcare LLC | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 372 Red Bud Ct., Frankfort, IL 60423-2128 | 2012-08-29 |
| 1518215284 | Paul Naffah | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 6161 So County Line Rd, Burr Ridge, IL 60527 | 2012-08-28 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.