VICTORIA J BROCKHOUSE (NPI# 1790744555) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790744555 |
| Entity Type | Individual |
| Full Name | VICTORIA J BROCKHOUSE |
| Credential | DO |
| Practice Address |
2540 College and University Normal IL 61790-2540 |
| Practice Telephone | 3094382956 |
| Practice Fax Number | 3094383689 |
| Mailing Telephone | 3094382956 |
| Mailing Fax Number | 3094383689 |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2019-11-14 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 336.043935 | IL | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | 036081580 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036081580 | 05 | |
| CONT SUBS | 336043935 | 01 | |
| IL | MEDICARE GROUP | 833120 | 01 |
| DEA | BB2556946 | 01 | |
| RR MEDICARE GROUP PTAN | CA2264 | 01 | |
| STATE LIC | 036081580 | 01 | |
| IL | RR MEDICARE GROUP PTAN | 080040113 | 01 |
| Street Address |
2540 COLLEGE AND UNIVERSITY |
| City | NORMAL |
| State | IL |
| Zip Code | 61790-2540 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982664314 | Linda C Meintscooper | Nurse Practitioner | 2540 College and University, Normal, IL 61790-2540 | 2006-03-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124478714 | Noelle Selkow | Specialist/Technologist | 251c Mcormick Hall, Campus Box 5120, Normal, IL 61790 | 2016-06-15 |
| 1679920375 | Yvette Renee Pigman | Nurse Practitioner | 201 North University, Illinois State Studnet Health Services, Normal, IL 61790 | 2016-05-23 |
| 1912263815 | Kelly Haley | Specialist/Technologist | 7130 Horton Fieldhouse, Normal, IL 61790 | 2012-04-04 |
| 1023391331 | Marie Rupert | Pharmacist | 201 N University Street, Normal, IL 61790 | 2011-09-22 |
| 1770615502 | Illinois State University | Psychologist | 408 Fairchild Hall, Campus Box 4625, Normal, IL 61790 | 2007-03-09 |
| 1578161865 | Abigail Hardesty | Nurse Practitioner | 201 Illinois State Univ, Normal, IL 61790-0001 | 2020-10-09 |
| 1245846989 | Susan M Carl | Nurse Practitioner | 201 North University Street, Normal, IL 61790-0001 | 2020-09-18 |
| 1891336277 | Rebecca Ludolph | Registered Nurse | 201 N University, Normal, IL 61790-0001 | 2019-10-07 |
| 1184188633 | Rachel Elizabeth Heinz | Specialist/Technologist | 347 Illinois State Univ, Normal, IL 61790-0001 | 2019-01-29 |
| 1487118063 | Jean Sawyer | Speech-Language Pathologist | Mail Code 4720, Normal, IL 61790-0001 | 2019-01-28 |
| Find all providers in zip 61790 | ||||
| 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 |
|---|---|---|---|---|
| 1467074138 | Carle West Physician Group Inc | Family Medicine | 1302 Franklin Ave Ste 3400, Normal, IL 61761-6523 | 2020-05-15 |
| 1023472636 | Ashraf Abdeljaber | Family Medicine | 1304 Franklin Ave Ste 380, Normal, IL 61761-3558 | 2016-04-09 |
| 1467834317 | Karen Akemi Sung Putty | Family Medicine | 1300 Franklin Ave Ste 110, Normal, IL 61761-3799 | 2015-06-26 |
| 1629311220 | Gbemisola Tolulope Olorode | Family Medicine | 1300 Franklin Ave Ste 380, Normal, IL 61761-4266 | 2013-04-02 |
| 1922206929 | Elaine Welch | Family Medicine | 2200 Fort Jesse Rd Ste 110, Normal, IL 61761-6286 | 2007-07-11 |
| 1083724405 | James Steven Vales | Family Medicine | 109 Veronica Way, Normal, IL 61761-1854 | 2006-08-30 |
| 1972619526 | Todd Owen Kettering | Family Medicine | 1300 Franklin Avenue, Suite 100, Normal, IL 61761 | 2006-08-23 |
| 1548288327 | Marcia K. Hauter | Family Medicine | 1302 Franklin Ave Lowr Level, Normal, IL 61761-3551 | 2006-07-18 |
| 1740207109 | Bromenn Physicians Management Corporation | Family Medicine | 403 W Virginia Ave, Normal, IL 61761-3666 | 2006-07-15 |
| 1164422663 | Timothy J Buffey | Family Medicine | 1300 Franklin Ave, Suite 100, Normal, IL 61761-3592 | 2005-07-26 |
| Find all providers in NORMAL | ||||
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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.