Active NPI
Rob Wimmer, P.A.
- Surgical Physician Assistant
- Peoria, IL
National Provider Identifier
1013972512
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- 085000410
- Practice address
- 7309 N Knoxville Ave
Peoria, IL 61614-2085 - Phone
- (309) 692-9898
- NPI assigned
- Apr 18, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 085000410 | IL | Primary |
Addresses
Primary practice location
7309 N Knoxville Ave
Peoria, IL 61614-2085
Mailing address
7309 N Knoxville Ave
Peoria, IL 61614-2085
Phone (309) 692-9898
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085000410 | IL | MD | Surgical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145318400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421798400000",
"number": "1013972512",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7309 N KNOXVILLE AVE",
"city": "PEORIA",
"state": "IL",
"postal_code": "616142085",
"telephone_number": "309-692-9898"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7309 N KNOXVILLE AVE",
"city": "PEORIA",
"state": "IL",
"postal_code": "616142085",
"telephone_number": "309-692-9898"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIMMER",
"first_name": "ROB",
"credential": "P.A.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-18",
"last_updated": "2015-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "IL",
"license": "085000410",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.