Delavan Pediatrics, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

036112406 Issued in IL

Legal business name

DELAVAN PEDIATRICS, LLC

Practice address

101 E 5TH St
Delavan, IL 61734-9619

Phone

(309) 244-8445

Fax

(309) 244-8452

NPI assigned

Jul 3, 2012

Last updated

Jul 3, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Joseph Flint, MDNPI 1013064195

Title

Owner/Physician

Phone

(309) 244-8445

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/23984/brand/1/csg/1/fhir/r4

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Joseph Flint, MD

  • Pediatrics Physician
  • Delavan, IL
  • NPI 1013064195
  NPD (past) Authorized official

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

{
    "created_epoch": "1341273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341273600000",
    "number": "1053675181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 E 5TH ST",
            "city": "DELAVAN",
            "state": "IL",
            "postal_code": "617349619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 E 5TH ST",
            "city": "DELAVAN",
            "state": "IL",
            "postal_code": "617349619",
            "telephone_number": "309-244-8445",
            "fax_number": "309-244-8452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELAVAN PEDIATRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-03",
        "last_updated": "2012-07-03",
        "status": "A",
        "authorized_official_last_name": "FLINT",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "309-244-8445",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "IL",
            "license": "036112406",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sandra Lynn Carrington, M.S.
• Delavan Ambulance Service Inc
• Delavan Cusd 703
• Joseph Flint, MD
• David Knapik
• Rachel Maple, C.N.A
• Jessica Danielle Maquet
• Jens Paul Nuesken, LPTA

• Clinic/Center in Delavan, IL
• Providers in Delavan, IL by specialty
• Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.