DR. JONATHAN GEORGE BARDAHL (NPI# 1932638186) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932638186 |
| Entity Type | Individual |
| Full Name | DR. JONATHAN GEORGE BARDAHL |
| Credential | DO |
| Practice Address |
1 Illini Dr Peoria IL 61605-2576 |
| Mailing Address |
530 Ne Glen Oak Ave Peoria IL 61637-0001 |
| Practice Telephone | 3096552274 |
| Enumeration Date | 2017-06-09 |
| Last Update Date | 2017-06-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | 125070431 | IL | Allopathic & Osteopathic Physicians |
| Street Address |
1 ILLINI DR |
| City | PEORIA |
| State | IL |
| Zip Code | 61605-2576 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134198856 | Richard Horndasch | Pediatrics | 1 Illini Dr, Medical Service Plan, Peoria, IL 61605-2576 | 2006-03-15 |
| 1306468822 | Kelly Goldsmith | Student in an Organized Health Care Education/Training Program | 1 Illini Dr, Peoria, IL 61605-2576 | 2020-05-07 |
| 1063047108 | George Elliot Tsourdinis | Student in an Organized Health Care Education/Training Program | 1 Illini Dr, Peoria, IL 61605-2576 | 2020-03-09 |
| 1912532110 | Alexandria Patricia Weston | Student in an Organized Health Care Education/Training Program | 1 Illini Dr, Peoria, IL 61605-2576 | 2020-03-08 |
| 1659928208 | Robert George | Student in an Organized Health Care Education/Training Program | 1 Illini Dr, Peoria, IL 61605-2576 | 2019-08-19 |
| 1649838327 | Megan Michelle Mccollum | Student in an Organized Health Care Education/Training Program | 1 Illini Dr, Peoria, IL 61605-2576 | 2019-05-29 |
| 1033774104 | Valerie Jaroenpuntaruk | Student in an Organized Health Care Education/Training Program | 1 Illini Dr, Peoria, IL 61605-2576 | 2019-05-04 |
| 1588186944 | Jeanna Rich | Dietitian, Registered | 1 Illini Dr, Peoria, IL 61605-2576 | 2017-07-07 |
| 1467980011 | Yuliya Belopolsky | Internal Medicine | 1 Illini Dr, Peoria, IL 61605-2576 | 2017-05-26 |
| 1821342973 | Roger William Geiss | Pathology | 1 Illini Dr, Department of Pathology, Peoria, IL 61605-2576 | 2012-10-27 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386131878 | Nicholas Anthony Helling | Physical Therapist | 518 W Romero B Garret Ave, Poeria, IL 61605 | 2018-04-19 |
| 1891241022 | Peoria Slf Lp | Assisted Living Facility | 518 West Romeo B. Garrett Avenue, Peoria, IL 61605 | 2016-08-28 |
| 1932479664 | Michelle L Whitelow | Nurse Practitioner | 711 W John Gwynn Jr. Avenue, Peoria, IL 61605 | 2012-01-11 |
| 1982852877 | Jason M Anane-sefah | Orthopaedic Surgery | 303 North Kumpf Boulevard, Peoria, IL 61605 | 2008-09-04 |
| 1902098908 | Calvary Elderly Home Help Program | Home Health | 1709 W Lincoln Ave, Peoria, IL 61605 | 2007-08-14 |
| 1023104437 | Thomas Anderson | Optometrist | 710 W Third Avenue, Peoria, IL 61605 | 2006-10-04 |
| 1841382298 | Devashish Agarwal | Family Medicine | 1701 W. Garden Street, Peoria, IL 61605 | 2006-09-29 |
| 1497763197 | Larry T Rolle | Pharmacist | 411 Martin Luther King Dr., Peoria, IL 61605 | 2006-08-04 |
| 1568404762 | Joseph P Kelly Iv | Physical Therapist | 303 N. Kumpf Blvd, Peoria, IL 61605 | 2006-06-12 |
| 1003861634 | Patrick William Elwood | Neurological Surgery | 719 N William Kumpf Blvd, Suite 100, Peoria, IL 61605 | 2006-05-23 |
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| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| 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/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780200865 | Kuang Chuen Liu | Pediatrics | 530 Ne Glen Oak Ave, Peoria, Peoria, IL 61637 | 2020-06-24 |
| 1578186839 | Katie Michelle Stapleton | Pediatrics | Osf St Francis Medical Center 530 Ne Glen Oak Avenue, Peoria, IL 61637-0001 | 2020-05-21 |
| 1760042162 | Paulette Padilla | Pediatrics | 3128 N Linnhill Ct, Peoria, IL 61604-1650 | 2019-06-18 |
| 1942799465 | Khaled Faisal Abdul Rahman | Pediatrics | 530 Ne Glen Oak Ave Bldg 5th, Peoria, IL 61637-0001 | 2018-05-10 |
| 1356859128 | Pleasant Pediatrics Plc | Pediatrics | 10204 W Happy Valley Rd Ste 165, Peoria, AZ 85383-2880 | 2018-01-16 |
| 1427408863 | Josef Newman | Pediatrics | 5654 N Building, 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2016-06-16 |
| 1962856054 | Brittany Nichole Vaio | Pediatrics | 9059 W Lake Pleasant Pkwy Suite E-540, Peoria, AZ 85382 | 2016-04-15 |
| 1790025591 | Pleasant Pediatrics Plc | Pediatrics | 9744 W Northern Ave, Suite 1310, Peoria, AZ 85345-4603 | 2013-02-15 |
| 1629365424 | May C Sun | Pediatrics | 2401 W Alta Rd Apt 905, Peoria, IL 61615-1290 | 2011-06-30 |
| 1205064003 | Sandhya Chaudhari | Pediatrics | 530 Ne Glran Oak Ave, Peoria, IL 61637-0001 | 2009-06-30 |
| 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.