LORI L PEGRAM (NPI# 1215947171) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215947171 |
| Entity Type | Individual |
| Full Name | LORI L PEGRAM |
| Credential | MD |
| Practice Address |
302 Saint Joseph Dr Bloomington IL 61701-3506 |
| Practice Telephone | 3096643100 |
| Practice Fax Number | 3096643027 |
| Mailing Telephone | 3096643100 |
| Mailing Fax Number | 3096643027 |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2014-04-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | 036072679 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | MEDICARE GROUP PTAN | IL2613 | 01 |
| Street Address |
302 SAINT JOSEPH DR |
| City | BLOOMINGTON |
| State | IL |
| Zip Code | 61701-3506 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871547414 | St Joseph Medical Center | Internal Medicine | 302 Saint Joseph Dr, Bloomington, IL 61701-3506 | 2006-05-19 |
| 1487012860 | Samina Yousuf | Pediatrics | 302 Saint Joseph Dr, Bloomington, IL 61701-3506 | 2016-02-01 |
| 1972681245 | Kristen Braun | Nurse Practitioner | 302 Saint Joseph Dr, Bloomington, IL 61701-3506 | 2006-11-02 |
| 1588756134 | Blair Valentine | Internal Medicine | 302 Saint Joseph Dr, Bloomington, IL 61701-3506 | 2006-09-29 |
| 1992804793 | Maria Rosa | Pediatrics | 302 Saint Joseph Dr, Bloomington, IL 61701-3506 | 2006-09-21 |
| 1144331828 | Stephen Trainor | Pediatrics | 302 Saint Joseph Dr, Bloomington, IL 61701-3506 | 2006-08-31 |
| 1275559270 | Jodie Dewey | Pediatrics | 302 Saint Joseph Dr, Bloomington, IL 61701-3506 | 2006-07-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770140964 | County of Mclean | Community/Behavioral Health | 200 W Front St, 1st Floor Sw, C/o 200 W Front St, Suite 400f, Bloomington, IL 61701 | 2019-05-22 |
| 1023525292 | Karli Johnson | Counselor | 200 W Monroe St Ste C7, Bloomington, IL 61701 | 2018-01-09 |
| 1487172409 | Melody Ann Bauman | Physician Assistant | 1505 Eastland Dr, Osf Critical Cane, Pulmonary, Sleep M, Bloomington, IL 61701 | 2017-08-30 |
| 1215396288 | Heidi Larsen | Social Worker | 902 S East St, Bloomington, IL 61701 | 2016-02-18 |
| 1558735126 | Andrea E. Andrews Counseling LLC | Counselor | 200 W. Monroe St., Ste 302 C, Bloomington, IL 61701 | 2015-11-19 |
| 1174924856 | Carole Hahn | Dietitian, Registered | 1406 Forrest St, Bloomington, IL 61701 | 2014-09-12 |
| 1558786392 | Valerie Colleen Parker | Counselor | 109 W. Mulberry St., Bloomington, IL 61701 | 2014-03-04 |
| 1124459219 | Matilde Francois | Surgery | 1505 Eastland Dr Ste 2300, Bloomington, IL 61701 | 2013-11-27 |
| 1922435114 | Smitha H Shivaprasad | Pharmacist | 2611 East Oakland Avenue, Bloomington, IL 61701 | 2013-10-02 |
| 1295161941 | Ashvin Patel | Obstetrics & Gynecology | 31 Country Club Pl, Bloomington, IL 61701 | 2013-09-25 |
| Find all providers in zip 61701 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255857926 | Kare Clinic | Internal Medicine | 1696 W Hennessey St, Bloomington, IN 47403-4645 | 2017-08-15 |
| 1669756060 | Dhanasarn Mongkolsmai | Internal Medicine | 2206 Berrywood Ln, Bloomington, IL 61704-2448 | 2011-10-04 |
| 1982906566 | Guy H Waldo | Internal Medicine | 9133 S Front Nine Drive, Bloomington, IN 47401-8151 | 2010-12-02 |
| 1154556843 | Primary Care Specialists, LLC | Internal Medicine | 2 Airline Dr, Suite 500, Bloomington, IL 61704-3433 | 2009-05-25 |
| 1790922201 | John Leeper Mcnay Jr. | Internal Medicine | 2032 S. Ramsey Dr., Bloomington, IN 47401-7153 | 2009-01-21 |
| 1790947539 | Jared A Frazin | Internal Medicine | 9332 Rich Rd, Bloomington, MN 55437-2074 | 2008-07-01 |
| 1114124575 | Joseph Michael Mackey | Internal Medicine | 1011 West Second Street, Bloomington, IN 47403-2216 | 2007-06-29 |
| 1588867386 | Virgil D. Short | Internal Medicine | 326 Fairway Dr, Bloomington, IL 61701-3462 | 2007-06-08 |
| 1013086792 | Daniel R Berg Md PC | Internal Medicine | 2620 North Walnut Street, Suite 400, Bloomington, IN 47404 | 2006-11-07 |
| 1386736023 | Jerry Antonini | Internal Medicine | 1505 Eastland Drive, Suite 320, Bloomington, IL 61701-3534 | 2006-09-29 |
| Find all providers in BLOOMINGTON | ||||
| City | BLOOMINGTON |
| Zip Code | 61701 |
Please comment or provide details below to improve the information on LORI L PEGRAM.
| 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.