METHODIST MEDICAL CENTER OF ILLINOIS (NPI# 1184670663) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184670663 |
| Entity Type | Organization |
| Organization Name | METHODIST MEDICAL CENTER OF ILLINOIS |
| Other Organization Name | METHODIST MEDICAL GROUP |
| Practice Address |
120 Ne Glen Oak Ave Suite 101 Peoria IL 61603 |
| Mailing Address |
5100 Reliable Pkwy Chicago IL 60686-0051 |
| Practice Telephone | 3096718230 |
| Practice Fax Number | 3096715118 |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2020-02-14 |
| Authorized Official Name | STEPHEN M. CIRONE (REGIONAL MGR-REIMB/REV RECOGNITION) |
| Authorized Official Telephone | 3096724813 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207P00000X | Emergency Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207RG0300X |
Internal Medicine Specialization: Geriatric Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 207RI0011X |
Internal Medicine Specialization: Interventional Cardiology |
Allopathic & Osteopathic Physicians | ||
| N | 207RR0500X |
Internal Medicine Specialization: Rheumatology |
Allopathic & Osteopathic Physicians | ||
| N | 207VM0101X |
Obstetrics & Gynecology Specialization: Maternal & Fetal Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| N | 208100000X | Physical Medicine & Rehabilitation | Allopathic & Osteopathic Physicians | ||
| N | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
Allopathic & Osteopathic Physicians | ||
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
Allopathic & Osteopathic Physicians | ||
| N | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
Allopathic & Osteopathic Physicians | ||
| N | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Allopathic & Osteopathic Physicians | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BCBS PPO | 7215059 | 01 |
| Other Name | Type Code |
|---|---|
| Methodist Medical Group | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780191437 | Methodist Medical Center of Illinois | Nurse Practitioner | 1615 N North St, Peoria, IL 61604-4131 | 2018-01-03 |
| 1629355060 | Methodist Medical Center of Illinois | Nurse Practitioner | 2702 W Krause Ave, Peoria, IL 61605-2905 | 2011-11-14 |
| 1124305636 | Methodist Medical Center of Illinois | Nurse Practitioner | 811 S Griswold St, Peoria, IL 61605-1458 | 2011-11-11 |
| 1265966048 | Methodist Medical Center of Illinois | Clinic/Center | 221 Ne Glen Oak Ave, Peoria, IL 61636-0001 | 2017-04-18 |
| 1447537881 | Methodist Medical Center of Illinois | Nurse Practitioner | 1419 S Folkers Ave, Peoria, IL 61605 | 2011-11-14 |
| 1326366790 | Methodist Medical Center of Illinois | Clinic/Center | 525 S Sweetbriar Dr, Chillicothe, IL 61523 | 2010-05-11 |
| 1407174873 | Methodist Medical Center of Illinois | Clinic/Center | 1112 5th St, Lacon, IL 61540 | 2010-05-11 |
| 1942528310 | Methodist Medical Center of Illinois | Clinic/Center | 223 E Main St, Princeville, IL 61559 | 2010-05-11 |
| 1710198379 | Methodist Medical Center of Illinois | Nurse Practitioner | 221 Ne Glen Oak Ave, Peoria, IL 61636-0001 | 2007-05-25 |
| 1821043365 | Methodist Medical Center of Illinois | Home Health | 221 Ne Glen Oak Ave, Peoria, IL 61636-0001 | 2006-05-23 |
| Street Address |
120 NE GLEN OAK AVE SUITE 101 |
| City | PEORIA |
| State | IL |
| Zip Code | 61603 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871047977 | Maren Thompson | Pharmacist | 120 Ne Glen Oak Ave, Suite 301, Peoria, IL 61603-4314 | 2016-08-08 |
| 1225234206 | Allergy and Asthma Carecenter Sc | Clinic/Center | 120 Ne Glen Oak Ave, Suite 408, Peoria, IL 61603-4314 | 2007-06-26 |
| 1063538940 | Joan K Selburg | Specialist/Technologist, Other | 120 Ne Glen Oak Ave, Suite 407, Peoria, IL 61603-4301 | 2007-03-22 |
| 1104986330 | Diane Lynn Dunniway | Nurse Practitioner | 120 Ne Glen Oak Ave, Suite 200, Peoria, IL 61603-4314 | 2006-12-11 |
| 1609936707 | Kindred LLC | Obstetrics & Gynecology | 120 Ne Glen Oak Ave, Suite 200, Peoria, IL 61603-4314 | 2006-12-11 |
| 1225145196 | Daniel W Palmer Jr. | Specialist | 120 Ne Glen Oak Ave, Suite 408, Peoria, IL 61603-4314 | 2006-08-24 |
| 1912912213 | Vaughn Hanna | Internal Medicine | 120 Ne Glen Oak Ave, Suite 100, Peoria, IL 61603-4314 | 2006-07-29 |
| 1811901929 | Joseph Couri | Internal Medicine | 120 Ne Glen Oak Ave, Suite 100, Peoria, IL 61603-4314 | 2006-07-27 |
| 1528089687 | Gurramkonda Naidu | Family Medicine | 120 Ne Glen Oak Ave, Suite 306, Peoria, IL 61603-4314 | 2006-07-22 |
| 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 | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922621739 | Titan Medical LLC | Family Medicine | 13660 N 94th Dr Ste D-3, Peoria, AZ 85381-4836 | 2020-05-27 |
| 1619516788 | Michelle Martin | Family Medicine | 15182 N 75th Ave # Uint180, Peoria, AZ 85381-4722 | 2020-01-06 |
| 1124667555 | District Medical Group, Inc | Family Medicine | 15182 N 75th Ave Ste 180, Peoria, AZ 85381-4722 | 2020-01-02 |
| 1831693514 | Summa Health Care, PC | Family Medicine | 8877 W Union Hills Dr Ste 240, Peoria, AZ 85382 | 2018-03-19 |
| 1992236848 | Agape Primary Care, Pllc | Family Medicine | 8380 W Emile Zola Ave # 5178, Peoria, AZ 85381-4811 | 2017-03-22 |
| 1043666910 | Honorhealth Medical Group, LLC | Family Medicine | 10230 W Happy Valley Rd, Ste100, Peoria, AZ 85383-2795 | 2016-05-10 |
| 1598160863 | Healthcare Partners Arizona Medical Group LLC | Family Medicine | 16155 N 83rd Ave Ofc, #201, Peoria, AZ 85382-5815 | 2014-10-29 |
| 1164856506 | Charlotte Christie Clayton | Family Medicine | 7505 N Edgewild Dr, Peoria, IL 61614-2117 | 2013-08-21 |
| 1770824112 | Dean Robert Bordeaux | Family Medicine | 7614 N Patton Ln, Peoria, IL 61614-1828 | 2013-03-11 |
| 1467731935 | James Austin Shane Jr. | Family Medicine | 18821 N 94th Ave, Peoria, AZ 85382-3697 | 2011-08-15 |
| Find all providers in PEORIA | ||||
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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.