OSF MULTISPECIALTY GROUP PEORIA LLC (NPI# 1770744799) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770744799 |
| Entity Type | Organization |
| Organization Name | OSF MULTISPECIALTY GROUP PEORIA LLC |
| Other Organization Name | CHILDREN'S HOSPITAL OF ILLINOIS MEDICAL GROUP |
| Practice Address |
420 Ne Glen Oak Ave Ste 304 Peoria IL 61603-3105 |
| Practice Telephone | 3096553453 |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2014-11-14 |
| Authorized Official Name | SISTER DIANE MARIE MCGREW (PRESIDENT/TREASURER) |
| Authorized Official Telephone | 3096552850 |
| Is Organization Subpart | Y |
| Parent Organization Name | OSF HEALTHCARE SYSTEM |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0202X |
Pediatrics Specialization: Pediatric Cardiology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| CHILDREN'S HOSPITAL OF ILLINOIS MEDICAL GROUP | Doing Business As Name - Organization |
| Street Address |
420 NE GLEN OAK AVE STE 304 |
| City | PEORIA |
| State | IL |
| Zip Code | 61603-3105 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427057595 | David P Chan | Pediatrics | 420 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2005-07-20 |
| 1164062196 | Tiara J Mullen | Nurse Practitioner | 420 Ne Glen Oak Ave, Peoria, IL 61603-3106 | 2020-01-07 |
| 1700308996 | Amanda Matthews | Nurse Practitioner | 420 Ne Glen Oak Ave, Peoria, IL 61603 | 2017-07-10 |
| 1871026450 | Shari S Mulvey | Pediatrics | 420 Ne Glen Oak Ave, Peoria, IL 61603-3105 | 2017-04-10 |
| 1003268897 | Sandra L. Peach | Nurse Practitioner | 420 Ne Glen Oak Ave, Peoria, IL 61603-3105 | 2016-07-06 |
| 1083062285 | Heather A Boore | Clinical Nurse Specialist | 420 Ne Glen Oak Ave, Suite 401, Peoria, IL 61603 | 2016-05-27 |
| 1336546969 | Jennifer A. Nelson | Nurse Practitioner | 420 Ne Glen Oak Ave, Suite 201, Peoria, IL 61603-3105 | 2014-11-25 |
| 1003219932 | Linda Schmidgall | Nurse Practitioner | 420 Ne Glen Oak Ave, Suite 200, Peoria, IL 61603-3105 | 2014-10-07 |
| 1164839692 | Gregory Puszkiewicz | Pharmacist | 420 Ne Glen Oak Ave, Peoria, IL 61603-3105 | 2014-07-16 |
| 1396183687 | Diana Warnecke | Nurse Practitioner | 420 Ne Glen Oak Ave, Ste 401, Peoria, IL 61603-3105 | 2013-06-07 |
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| 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 |
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| Taxonomy Code | 2080P0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Cardiology |
| A pediatric cardiologist provides comprehensive care to patients with cardiovascular problems. This specialist is skilled in selecting, performing and evaluating the structural and functional assessment of the heart and blood vessels, and the clinical evaluation of cardiovascular disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pediatrics. The Certification is no longer offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740483627 | Priti M. Patel | Pediatrics | 530 Ne Glenoak Ave, Peoria, IL 61603-3133 | 2007-06-07 |
| 1427057595 | David P Chan | Pediatrics | 420 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2005-07-20 |
| 1386081792 | Children's Hospital of Illinois Medical Group | Pediatrics | 420 Ne Glen Oak Ave, Ste 301, Peoria, IL 61603-3105 | 2013-05-24 |
| 1851644256 | Jeffrey William Orcutt Jr. | Pediatrics | 420 Ne Glen Oak Ave, Ste 301, Peoria, IL 61603-3105 | 2012-10-23 |
| 1013146067 | Saint Francis Medical Center | Pediatrics | 420 Ne Glen Oak Ave, Suite 304, Peoria, IL 61603-3105 | 2009-07-13 |
| 1164689428 | Matthew T Bramlet | Pediatrics | 420 Ne Glen Oak Ave, Suite 301, Peoria, IL 61603-3105 | 2008-05-22 |
| 1497879290 | Cecilia Anne Albaro | Pediatrics | 420 Ne Glen Oak Ave, Suite 301, Peoria, IL 61603-3105 | 2007-03-19 |
| 1982798146 | William H Albers | Pediatrics | 420 Ne Glen Oak Ave, Suite 304, Peoria, IL 61603-3105 | 2006-10-03 |
| 1619061827 | Jitendra J Shah | Pediatrics | 420 Ne Glen Oak Ave, Suite 304, Peoria, IL 61603-3105 | 2006-10-03 |
| 1417041666 | Stephen E Bash | Pediatrics | 420 Ne Glen Oak Ave, Suite 304, Peoria, IL 61603-3105 | 2006-10-03 |
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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.