Individual provider Active NPI

Paul Stuart Moots, MD

  • Internal Medicine Physician
  • Peoria, IL
National Provider Identifier
1083047401
Registry record updated Aug 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
125064267 Issued in IL
Practice address
929 W Loire CT
Apt 1211
Peoria, IL 61614-1850
Phone
(217) 825-4072
NPI assigned
Aug 21, 2013
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 21, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 125064267 IL Primary

Addresses

Primary practice location

929 W Loire CT
Apt 1211
Peoria, IL 61614-1850

Mailing address

929 W. Loire CT
Apt 1211
Peoria, IL 61614
Phone (217) 825-4072

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: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160720002972 IL Practitioner - HospitalistPractitioner - Internal Medicine 3971824731 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2012
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)

530 NE Glen Oak Ave
Peoria, IL 61637-0001
Phone (877) 464-6640

Hospital & facility affiliations

  • Saint Francis Medical Center Hospital, Peoria, IL, CCN 140067
  • Saint James Hospital Hospital, Pontiac, IL, CCN 140161
  • Osf Saint Luke Medical Center Hospital, Kewanee, IL, CCN 141325

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
125064267ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Osf Multi-Specialty Group Internal Medicine CurrentSince Jul 1, 2016 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Cardinal Medical Group, LTD. Past Accepting new patients

Locations

1 N Logan Ave
Danville, IL 61832
Phone (217) 554-6827

853 W Jackson St
Morton, IL 61550

5660 W 95th St
Ste 1
Oak Lawn, IL 60453
Phone (708) 499-2273

2911 Columbus St
Ottawa, IL 61350
Phone (815) 431-3410

530 NE Glen Oak Ave
Peoria, IL 61637
Phone (309) 655-2553

1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195

10408 N Centerway Dr
Ste C
Peoria, IL 61615

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

3626 N Sheridan Rd
Peoria, IL 61604

530 Neglen Oak Ave
Peoria, IL 61637
Phone (877) 464-6640

5209 W War Memorial Dr
Peoria, IL 61615

1986 Freedom Pkwy
Ste 1
Washington, IL 61571

Organizations & group practices 3

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1377043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377043200000",
    "number": "1083047401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "929 W. LOIRE CT",
            "address_2": "APT 1211",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "61614",
            "telephone_number": "217-825-4072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "929 W LOIRE CT",
            "address_2": "APT 1211",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616141850",
            "telephone_number": "217-825-4072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOOTS",
        "first_name": "PAUL",
        "middle_name": "STUART",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-08-21",
        "last_updated": "2013-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125064267",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.