Individual provider Active NPI

Samantha Robbins, APN

  • Family Nurse Practitioner
  • Peoria, IL
National Provider Identifier
1093113854
Registry record updated Dec 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209.012037 Issued in IL
Practice address
530 NE Glen Oak Ave
Pediatric Diabetes Resource Center
Peoria, IL 61637
Phone
(309) 624-2480
Fax
(309) 624-2481
NPI assigned
Dec 10, 2014
Last updated
Dec 10, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209.012037 IL Primary
Registered Nurse 163W00000X 041.362542 IL

Addresses

Primary practice location

530 NE Glen Oak Ave
Pediatric Diabetes Resource Center
Peoria, IL 61637

Mailing address

530 NE Glen Oak Ave
Pediatric Diabetes Resource Center
Peoria, IL 61637
Phone (309) 624-2480

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150408000648 IL Practitioner - Nurse Practitioner 1153649900 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
041.362542ILMDRegistered Nurse
209.012037ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Board of Trustees of the University of Illinois CurrentSince Dec 9, 2014 Accepting new patients
The Board of Trustees of the University of Illinois Current Accepting new patients
Board of Trustees of the University of Illinois CurrentSince Dec 9, 2014 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Mar 11, 2019 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

7694 Solutions Ctr
Chicago, IL 60677

1 Illini Dr
Peoria, IL 61605
Phone (309) 671-3000

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

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

530neglen Oak Ave
Peoria, IL 61637
Phone (309) 692-5393

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

Organizations & group practices 6

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": "1418169600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418169600000",
    "number": "1093113854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "address_2": "PEDIATRIC DIABETES RESOURCE CENTER",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "61637",
            "telephone_number": "309-624-2480",
            "fax_number": "309-624-2481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "address_2": "PEDIATRIC DIABETES RESOURCE CENTER",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "61637",
            "telephone_number": "309-624-2480",
            "fax_number": "309-624-2481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBBINS",
        "first_name": "SAMANTHA",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-10",
        "last_updated": "2014-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.012037",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041.362542",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.