Holly Vannitamby, DO

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036150954 Issued in IL

Practice address

6339 N Big Hollow Rd
Peoria, IL 61615-2907

Phone

(309) 693-3315

Fax

(309) 693-9385

NPI assigned

Jun 20, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 2017

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)

Hospital & facility affiliations

• St. Francis Medical Center Home health agency, Peoria, IL, CCN 147243
• Saint Francis Medical Center Hospital, Peoria, IL, CCN 140067
• Carle Health Methodist Hospital Hospital, Peoria, IL, CCN 140209

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Osf Multi-Specialty Group

  • Internal Medicine Physician
  • Peoria, IL
  • NPI 1922445527
  Medicare reassignment Care Compare group NPD
• Central PA Pharmacy LLC.

  dba patton pharmacy and v&s variety

  • Community/Retail Pharmacy
  • Patton, PA
  • NPI 1578541413
  NPD

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

• Methodist Medical Center of Illinois

  • General Acute Care Hospital
  • Peoria, IL
  • NPI 1164474755
  Care Compare affiliation
• Saint Francis Medical Center

  dba Saint Francis Home Health

  • Home Health Agency
  • Peoria, IL
  • NPI 1346281425
  Care Compare affiliation

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

{
    "created_epoch": "1497916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595808000000",
    "number": "1053831214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 MAIN ST STE A",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616021080",
            "telephone_number": "309-672-4977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6339 N BIG HOLLOW RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616152907",
            "telephone_number": "309-693-3315",
            "fax_number": "309-693-9385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANNITAMBY",
        "first_name": "HOLLY",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-20",
        "last_updated": "2020-07-27",
        "certification_date": "2020-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036150954",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "125.071177",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036.150954",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Caroline Vanaman
• Clark O Vandegraft, PTA
• Aaron Thomas Vangeest
• Heidi M Vanheuklon, LCPC
• Bethany Vanne, L.C.P.C.
• Martin Varela, OD
• Scot L Varness, D.C.
• Elsa L Vazquez Melendez, MD
• Michael H Veeder, MD
• Ralph R. Velazquez Jr., M.D.

• Internal Medicine Physician in Peoria, IL
• Providers in Peoria, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2020; 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.
• 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.