UNIVERSITY OF ILLINOIS (NPI# 1962475996) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962475996 |
| Entity Type | Organization |
| Organization Name | UNIVERSITY OF ILLINOIS |
| Other Organization Name | MEDICAL SERVICE PLAN AT PEORIA |
| Practice Address |
Dept. of Ob / Gyn 530 Ne Glen Oak Peoria IL 61637-0001 |
| Mailing Address |
1 Illini Dr Peoria IL 61605-2576 |
| Practice Telephone | 3096553024 |
| Mailing Telephone | 3096718503 |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | WILLIAM R NICHOLAS (EXECUTIVE DIRCETOR OF MSP) |
| Authorized Official Telephone | 3124130573 |
| Authorized Official Credential | PHD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207V00000X | Obstetrics & Gynecology | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BCBS | 07215036 | 01 |
| Other Name | Type Code |
|---|---|
| Medical Service Plan at Peoria | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659431351 | University of Illinois | Public Health or Welfare | 2815 W Washington, Suite 300, Springfield, IL 62794-9481 | 2006-12-11 |
| 1861409450 | University of Illinois | Audiologist | 2001 S Oak St Ste B, Champaign, IL 61820-0912 | 2006-08-03 |
| 1174596225 | University of Illinois | Pediatrics | 515 Ne Glen Oak Ave, Pediatric Neurology, Peoria, IL 61603-3165 | 2006-02-09 |
| 1245203280 | University of Illinois | Psychiatry & Neurology | Department of Psychiatry, 221 Ne Glen Oak 7 West, Peoria, IL 61636-0001 | 2006-02-09 |
| 1568433050 | University of Illinois | Pediatrics | St Jude Midwest Affiliate, 530 Ne Glen Oak, Peoria, IL 61637-0001 | 2006-02-01 |
| 1619948411 | University of Illinois | Pediatrics | Regional Development Center, 507 E Armstrong, Peoria, IL 61603 | 2006-01-30 |
| 1275817249 | University of Illinois | General Acute Care Hospital | 611 W Park St, Carle Forum, Urbana, IL 61801-2500 | 2011-10-07 |
| 1871725028 | University of Illinois | Internal Medicine | 840 S Wood St, Department of Medicine, M/c 787, Chicago, IL 60612-4325 | 2009-08-20 |
| 1962631010 | University of Illinois | Psychologist | 1747 W Roosevelt Rd, Chicago, IL 60608-1264 | 2009-07-10 |
| 1205002185 | University of Illinois | General Acute Care Hospital | 611 W Park St, Carle Forum Lower Level, Urbana, IL 61801-2500 | 2008-05-01 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | UNIVERSITY OF ILLINOIS | 809 S Marshfield 9th Flr, Chicago, IL 60612-4305 |
| Oklahoma Business Registrations | UNIVERSITY OF ILLINOIS FOUNDATION | 1305 West Green St, Urbana, IL 61801 |
| System for Award Management (SAM) Entities | UNIVERSITY OF ILLINOIS RESEARCH PARK, LLC | 60 Hazelwood Dr, Champaign, IL 61820-7460 |
| Street Address |
DEPT. OF OB / GYN 530 NE GLEN OAK |
| City | PEORIA |
| State | IL |
| Zip Code | 61637-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780200865 | Kuang Chuen Liu | Pediatrics | 530 Ne Glen Oak Ave, Peoria, Peoria, IL 61637 | 2020-06-24 |
| 1174184527 | Manisha Tharoor | Student in an Organized Health Care Education/Training Program | 530 N.e Glen Oak Ave, Peoria, IL 61637 | 2019-06-26 |
| 1609436724 | Sriviji Senthil Kumaran | Student in an Organized Health Care Education/Training Program | 530. N.e Glen Oak Ave., Peoria, IL 61637 | 2019-06-20 |
| 1780240929 | Abuzar Ali Asif | Student in an Organized Health Care Education/Training Program | 530 N. E. Glen Oak Ave., Peoria, IL 61637 | 2019-05-14 |
| 1518328665 | Jenna Bishop | Dietitian, Registered | 600 Ne Water Street, Peoria, IL 61637 | 2016-03-17 |
| 1194133850 | Ashish Kumar Roy | Internal Medicine | 530 N.e. Glen Oak Ave, Peoria, IL 61637 | 2014-07-25 |
| 1265720510 | Reuben Antony | Pediatrics | 530 Ne Glen Oak Ave., C/o Ms Suzy Lewellen, Peoria, IL 61637 | 2011-07-20 |
| 1366673436 | Joseph William Hauter | Emergency Medicine | 830 Ne Glen Oak Ave, Peoria, IL 61637 | 2009-08-06 |
| 1437380748 | Jeremy R Monroe | Emergency Medicine | 530 Glen Oak, Osf St Francis Medical Center, Peoria, IL 61637 | 2009-08-04 |
| 1326244682 | Maria S. Parr | Psychiatry & Neurology | Osf Saint Francis Medical Center, 530 N.e.glen Oak Ave., Peoria, FL 61637 | 2007-06-25 |
| Find all providers in zip 61637 | ||||
| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083097000 | Pilar Mckay Rainey | Obstetrics & Gynecology | 530 Ne Glen Oak, Peoria, IL 61634-0001 | 2015-07-08 |
| 1881084838 | Pinnacle Women's Center LLC | Obstetrics & Gynecology | 15396 N 83rd Ave Ste F100, Peoria, AZ 85381 | 2015-01-29 |
| 1124468129 | Kaleb L. Jacobs | Obstetrics & Gynecology | 6708 N. Knoxville Ave, Suite 1, Peoria, IL 61614 | 2013-07-05 |
| 1093062077 | Rejuv David Kindred, PC | Obstetrics & Gynecology | 2806 N Knoxville Ave, Peoria, IL 61604-2870 | 2012-08-09 |
| 1528368875 | Couri Center for Gynecology and Integrative Womens Health Sc | Obstetrics & Gynecology | 6708 North Knoxville Ave, Suite 1, Peoria, IL 61614 | 2010-11-02 |
| 1376787523 | Vanessa Marie Cameron | Obstetrics & Gynecology | 8600 N Sate Route 91, Suite 330, Peoria, IL 61615 | 2009-04-30 |
| 1437311651 | Marquia T Redden-grier | Obstetrics & Gynecology | 21755 N 77th Ave, Suite E-1200, Peoria, AZ 85382-2111 | 2008-06-29 |
| 1023298916 | Edward C Luan Md Sc | Obstetrics & Gynecology | 7620 N University St Ste 108, Peoria, IL 61614-8300 | 2007-11-07 |
| 1881893212 | Xochitl Lorena Garcia | Obstetrics & Gynecology | 2901 N. Knoxville Ave, Peoria, IL 61603-1747 | 2007-07-16 |
| 1881810224 | Ali Azadi | Obstetrics & Gynecology | Star Clinic/star Urogynecology, 14155 N 83rd Ave, Bld 6, Suite 138, Peoria, AZ 85381 | 2007-04-17 |
| Find all providers in PEORIA | ||||
Please comment or provide details below to improve the information on UNIVERSITY OF ILLINOIS.
| 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.