Individual provider Active NPI

Ryan Eugene Parnham, NP-C

  • Family Nurse Practitioner
  • Peoria, IL
National Provider Identifier
1003015447
Registry record updated Mar 17, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209006653 Issued in IL
Practice address
530 NE Glen Oak Ave
Suite 108
Peoria, IL 61537-3167
Phone
(309) 624-8818
NPI assigned
Jul 16, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209006653 IL Primary

Addresses

Primary practice location

530 NE Glen Oak Ave
Suite 108
Peoria, IL 61537-3167

Mailing address

530 NE Glen Oak Ave
Suite 108
Peoria, IL 61537-3167
Phone (309) 624-8818

Other identifiers 1

IdentifierTypeStateIssuer
809840OtherILMEDICARE GROUP NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080223000060 IL Practitioner - Nurse Practitioner 2163506544 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

435 Maxine Dr
Morton, IL 61550-2498
Phone (309) 266-5405

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Osf Multi-Specialty Group CurrentSince Jan 1, 2016 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients

Locations

435 Maxine Dr
Morton, IL 61550
Phone (309) 263-2424

530 NE Glen Oak Ave
Peoria, IL 61637
Phone (309) 655-2553

1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195

530 NE Glen Oak Ave
Ste 108
Peoria, IL 61637
Phone (309) 624-8818

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

420 NE Glen Oak Ave
Ste 304
Peoria, IL 61603
Phone (877) 464-6640

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1237248000000",
    "number": "1003015447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "address_2": "SUITE 108",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "615373167",
            "telephone_number": "309-624-8818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "address_2": "SUITE 108",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "615373167",
            "telephone_number": "309-624-8818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARNHAM",
        "first_name": "RYAN",
        "middle_name": "EUGENE",
        "name_prefix": "Mr.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-16",
        "last_updated": "2009-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209006653",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "809840",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.