ILLINOIS GASTROENTEROLOGY INSTITUTE, PLLC (NPI# 1275575706) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275575706 |
| Entity Type | Organization |
| Organization Name | ILLINOIS GASTROENTEROLOGY INSTITUTE, PLLC |
| Other Organization Name | GASTROENTEROLOGY, LTD |
| Practice Address |
1001 Main St Suite 500a Peoria IL 61606-1907 |
| Mailing Address |
Po Box 365 Morton IL 61550-0365 |
| Practice Telephone | 3096724980 |
| Practice Fax Number | 3096712944 |
| Mailing Telephone | 3096724980 |
| Mailing Fax Number | 3096712944 |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2020-08-17 |
| Authorized Official Name | MIKE SHADLEY (ADMINISTRATOR) |
| Authorized Official Telephone | 3096724980 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
042006270 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BLUE CROSS | 07215152 | 01 |
| IL | RAILROAD MEDICARE | CE0700 | 01 |
| Other Name | Type Code |
|---|---|
| Gastroenterology, Ltd | Former Legal Business Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649765835 | Illinois Gastroenterology Institute, Pllc | Nurse Anesthetist, Certified Registered | 1001 Main St Ste 500a, Peoria, IL 61606-2038 | 2018-06-29 |
| Street Address |
1001 MAIN ST SUITE 500A |
| City | PEORIA |
| State | IL |
| Zip Code | 61606-1907 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356719736 | Rachel Delong | Nurse Practitioner | 1001 Main St, Suite 300, Peoria, IL 61606-1907 | 2015-09-02 |
| 1730456914 | Justin Lee Fischer | Colon & Rectal Surgery | 1001 Main St, Ste 300, Peoria, IL 61606-2036 | 2011-11-16 |
| 1588956635 | Chadrick Ryan Evans | Surgery | 1001 Main St, Suite 300, Peoria, IL 61606-1907 | 2011-05-09 |
| 1518260199 | Jodi Renee Stoner | Clinical Nurse Specialist | 1001 Main St, Suite 200, Peoria, IL 61606-1907 | 2010-12-21 |
| 1881906410 | Heather Jefford | Clinical Nurse Specialist | 1001 Main St, 3rd Floor, Peoria, IL 61606 | 2010-07-12 |
| 1124344023 | Jamie Doubet | Registered Nurse | 1001 Main St, 3rd Floor, Peoria, IL 61606-1907 | 2010-04-16 |
| 1114258167 | Ryan M Dunn | Internal Medicine | 1001 Main St, Suite 200, Peoria, IL 61606-1907 | 2010-01-14 |
| 1134352842 | Illinois Specialty Physician Services At Osf, LLC | Internal Medicine | 1001 Main St, Ste 200, Peoria, IL 61606-1907 | 2009-08-27 |
| 1154555852 | Brynn N Cinnamon | Registered Nurse | 1001 Main St, Suite 500a, Peoria, IL 61606-1907 | 2009-05-08 |
| 1790924306 | Central Illinois Endoscopy Center, LLC | Clinic/Center | 1001 Main St, Ste 530, Peoria, IL 61606-1907 | 2009-02-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194292334 | Kelley Stork | Speech-Language Pathologist | 807 W Columbia Terrace, Peoria, IL 61606 | 2018-10-25 |
| 1689140519 | Emma Cristine Tully | Speech-Language Pathologist | 1619 W. Fredonia Ave, Peoria, IL 61606 | 2018-10-18 |
| 1316492432 | Jennifer Greenwood | Nurse Practitioner | 1001 Main St Ste 500a, Peoria, IL 61606 | 2016-08-18 |
| 1104944974 | Robert I Martin | Preventive Medicine | 1127 N North Street, Peoria, IL 61606 | 2007-03-27 |
| 1023062312 | Saint Francis Medical Center | Physical Medicine & Rehabilitation | 100 Ne Randoph Street, Peoria, IL 61606 | 2006-05-20 |
| 1174573307 | Cpo Services, Inc | Prosthetic/Orthotic Supplier | 741 West Main Street, Peoria, IL 61606 | 2006-05-10 |
| 1174025357 | Amy M Durst | Nurse Practitioner | 1001 Main St Ste 500a, Peoria, IL 61606 | 2018-03-05 |
| 1538471099 | Jacob Royle Hopping | Surgery | 1001 Main St Ste 300, Peoria, IL 61606 | 2010-07-12 |
| 1306874128 | David L Crawford | Surgery | 1001 Main Street, Suite 300, Peoria, IL 61606 | 2006-06-29 |
| 1205864170 | Norman C Estes | Surgery | 1001 Main Street, Suite 300, Peoria, IL 61606 | 2006-06-29 |
| Find all providers in zip 61606 | ||||
| Taxonomy Code | 207RG0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Gastroenterology |
| An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal 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 |
|---|---|---|---|---|
| 1053932327 | Honorhealth Ambulatory | Internal Medicine | 9059 W Lake Pleasant Pkwy Ste 320, Peoria, AZ 85382-8362 | 2020-04-28 |
| 1649539255 | Arizona Gastroenterology Clinic LLC | Internal Medicine | 14155 N 83rd Ave Ste 122, Peoria, AZ 85381-5640 | 2012-05-16 |
| 1659390342 | Deepa K Shah | Internal Medicine | 13640 N Plaza Del Rio Blvd Ste 340, Peoria, AZ 85381-4846 | 2006-07-19 |
| 1730143165 | Malvinderjit Singh | Internal Medicine | 13634 N 93rd Ave Ste 200, Peoria, AZ 85381 | 2006-04-13 |
| 1639168222 | Gloria Isabel Diaz | Internal Medicine | 2805 N Knoxville Ave, Peoria, IL 61604-2869 | 2005-10-17 |
| 1922605294 | Digestive Health Clinic, Pllc | Internal Medicine | 13634 N 93rd Ave Ste 200, Peoria, AZ 85381-4915 | 2020-10-08 |
| 1043849458 | Anesthesia Services for Gi LLC | Internal Medicine | 14155 N 83rd Ave Ste 122, Peoria, AZ 85381-5640 | 2020-04-07 |
| 1588831721 | Abdullah Al-rashdan | Internal Medicine | 1001 Main St, Suite 500a, Peoria, IL 61606-1907 | 2008-05-15 |
| 1447351077 | Fritz-henry Volmar | Internal Medicine | 2805 N Knoxville Ave, Suite 209, Peoria, IL 61604-2869 | 2006-09-26 |
| 1346276284 | Terry L Baldwin | Internal Medicine | 1001 W Main St, Suite 500a, Peoria, IL 61606-1276 | 2006-06-23 |
| 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.