Med-Peds Associates,P.C.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036074737 Issued in IL

Legal business name

MED-PEDS ASSOCIATES,P.C.

Practice address

375 N Wall St
Ste P520
Kankakee, IL 60901-3483

Phone

(815) 933-0194

Fax

(815) 933-1444

NPI assigned

Mar 21, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Stonewall McCuiston Jr., M.D.NPI 1720072143

Title

President

Phone

(815) 933-0194

Specialties & licenses 2

Addresses

Other identifiers 2

Tax ID family

Med Peds Associates2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Med Peds Associates

  • Non-Pharmacy Dispensing Site
  • Kankakee, IL
  • NPI 1649353970
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stonewall McCuiston Jr., MD

  • Pediatrics Physician
  • Kankakee, IL
  • NPI 1720072143

  Internal Medicine

  NPD (past) Authorized official
• Rodney Alford, M.D.

  • Internal Medicine Physician
  • Kankakee, IL
  • NPI 1427128909
  NPD (past)

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287532800000",
    "number": "1063538312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 N WALL ST",
            "address_2": "STE P520",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609013483",
            "telephone_number": "815-933-0194",
            "fax_number": "815-933-1444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 N WALL ST",
            "address_2": "STE P520",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609013483",
            "telephone_number": "815-933-0194",
            "fax_number": "815-933-1444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MED-PEDS ASSOCIATES,P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2010-10-20",
        "status": "A",
        "authorized_official_last_name": "MCCUISTON",
        "authorized_official_first_name": "STONEWALL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-933-0194",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036074737",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036074737",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036074737",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD OF ILLINOIS",
            "identifier": "4623239",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michelle Renee McKay
• Tracy R McKenney, LCPC
• Martin Briggs McNab Jr., CPO
• Shelby Lynn Meadows, RN
• Med Peds Associates
• Medcentre Pharmacy
• Medical Associates of Kankakee PC
• Mediexperts, LLC
• Shital Tapan Mehta, M.D.
• Ryan J Meiners, MD

• Pediatrics Physician in Kankakee, IL
• Providers in Kankakee, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2010; 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.