EDWARD W PEGG MD, LLC (NPI# 1568667772) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568667772 |
| Entity Type | Organization |
| Organization Name | EDWARD W PEGG MD, LLC |
| Practice Address |
1505 Eastland Dr Ste 2400 Bloomington IL 61701-7911 |
| Practice Telephone | 3096617344 |
| Practice Fax Number | 3096617343 |
| Mailing Telephone | 3096617344 |
| Mailing Fax Number | 3096617343 |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2008-05-29 |
| Authorized Official Name | EDWARD W PEGG III (OWNER) |
| Authorized Official Telephone | 3096617344 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
036071077 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BCBS | 05732102 | 01 |
| IL | INDIVIDUAL NPI | 1043392160 | 01 |
| Street Address |
1505 EASTLAND DR STE 2400 |
| City | BLOOMINGTON |
| State | IL |
| Zip Code | 61701-7911 |
| 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 | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083848550 | David W Harvey | Psychiatry & Neurology | 321 S Landmark Ave, Bloomington, IN 47403-5001 | 2009-05-12 |
| 1245248293 | Jameson Daniel Way | Psychiatry & Neurology | 2315 E 3rd St, Bloomington, IN 47401-5320 | 2006-08-04 |
| 1760431712 | Mclean County Neurology Sc | Psychiatry & Neurology | 2204 Eastland Dr, Bloomington, IL 61704-3566 | 2006-05-08 |
| 1689150948 | Barbara Luann Weis | Psychiatry & Neurology | 1701 E College Ave, Bloomington, IL 61704-2101 | 2018-07-18 |
| 1770038069 | Supriya Kairamkonda | Psychiatry & Neurology | 583 S Clarizz Blvd, Bloomington, IN 47401-5515 | 2016-08-17 |
| 1336403237 | Derrick Alwyn Fox | Psychiatry & Neurology | 1701 E College Ave, Bloomington, IL 61704-2101 | 2012-06-26 |
| 1477875938 | Mehyar Mehrizi | Psychiatry & Neurology | 583 S Clarizz Blvd, Bloomington, IN 47401-5515 | 2010-02-24 |
| 1326233271 | Barry Jay Riskin | Psychiatry & Neurology | 2502 E Empire St, Bloomington, IL 61704-3738 | 2007-09-12 |
| 1194865642 | Neurology Specialists, PC | Psychiatry & Neurology | 813 W 2nd St, Bloomington, IN 47403-2212 | 2007-02-07 |
| 1043392160 | Edward W Pegg IIi | Psychiatry & Neurology | 1505 Eastland Dr, Suite 2400, Bloomington, IL 61701-3534 | 2006-10-19 |
| Find all providers in BLOOMINGTON | ||||
| City | BLOOMINGTON |
| Zip Code | 61701 |
Please comment or provide details below to improve the information on EDWARD W PEGG MD, LLC.
| 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.