Individual provider Active NPI

Joy L Meachum, LCSW

  • Clinical Social Worker
  • Peoria, IL
National Provider Identifier
1053801191
Registry record updated May 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149017187 Issued in IL
Practice address
5114 N Glen Park Place Rd
Peoria, IL 61614-4686
Phone
(309) 683-8100
Fax
(309) 683-8149
NPI assigned
May 15, 2018
Last updated
May 15, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 149017187 IL Primary

Addresses

Primary practice location

5114 N Glen Park Place Rd
Peoria, IL 61614-4686

Mailing address

5114 N Glen Park Place Rd
Peoria, IL 61614-4686
Phone (309) 683-8100

Other names 1

  • Joy L Theobald Former name

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180702000787 IL Practitioner - Clinical Social Worker 4688920804 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osf Healthcare SystemGroup PAC ID 4284541806, 94 clinicians

Practice addresses (Care Compare)

327 Edward St
Osf Healthcare Medical Group Henry
Henry, IL 61537-1539
Phone (309) 364-2002

535 Park Ave E
Princeton, IL 61356-2537
Phone (815) 875-4531

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Osf Healthcare System CurrentSince Feb 22, 2023 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Healthcare System Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Jun 1, 2018 Accepting new patients
Osf Healthcare System CurrentSince Feb 22, 2023 Accepting new patients

Locations

327 Edward St
Henry, IL 61537
Phone (309) 364-2002

1000 W Harlem Ave
Monmouth, IL 61462
Phone (309) 734-1414

5114 N Glen Park Place Rd
Peoria, IL 61614
Phone (309) 655-2431

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

Organizations & group practices 5

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

NPI Registry JSON

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

{
    "created_epoch": "1526342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526342400000",
    "number": "1053801191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5114 N GLEN PARK PLACE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144686",
            "telephone_number": "309-683-8100",
            "fax_number": "309-683-8149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5114 N GLEN PARK PLACE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144686",
            "telephone_number": "309-683-8100",
            "fax_number": "309-683-8149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEACHUM",
        "first_name": "JOY",
        "middle_name": "L",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-15",
        "last_updated": "2018-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149017187",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JOY",
            "last_name": "THEOBALD",
            "middle_name": "L",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.