St. Margaret's Health-Peru

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

ST. MARGARET'S HEALTH-PERU

Doing business as

Ivch Medical Group / Hennepin Medical Clinic
SMH-Peru/Hennepin Medical Clinic

Practice address

220 E High St
Hennepin, IL 61327-9424

Phone

(815) 925-7032

Fax

(815) 925-7463

NPI assigned

Jan 12, 2012

Last updated

Jan 27, 2021By the provider in NPPES

Organization subpart

Yes

Parent organization

ST. MARGARET'S HEALTH-PERUAs reported in NPPES

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

Authorized official

Name

Dori Bonnell

Title

Director of Physician Practices

Phone

(815) 780-3222

Specialties & licenses 1

Addresses

Other names 2

• IVCH MEDICAL GROUP / HENNEPIN MEDICAL CLINIC Doing business as
• SMH-Peru/Hennepin Medical Clinic Doing business as

Part of

Illinois Valley Community

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

{
    "created_epoch": "1326326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611705600000",
    "number": "1013288646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1305 6TH ST",
            "city": "PERU",
            "state": "IL",
            "postal_code": "613542759",
            "telephone_number": "815-223-3500",
            "fax_number": "815-780-4634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 E HIGH ST",
            "city": "HENNEPIN",
            "state": "IL",
            "postal_code": "613279424",
            "telephone_number": "815-925-7032",
            "fax_number": "815-925-7463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MARGARET'S HEALTH-PERU",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. MARGARET'S HEALTH-PERU",
        "enumeration_date": "2012-01-12",
        "last_updated": "2021-01-27",
        "certification_date": "2021-01-27",
        "status": "A",
        "authorized_official_last_name": "BONNELL",
        "authorized_official_first_name": "DORI",
        "authorized_official_title_or_position": "DIRECTOR OF PHYSICIAN PRACTICES",
        "authorized_official_telephone_number": "815-780-3222"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IVCH MEDICAL GROUP / HENNEPIN MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SMH-Peru/Hennepin Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Nurse Practitioner in Hennepin, IL
• Providers in Hennepin, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.