MJM Family Medicine SC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MJM FAMILY MEDICINE SC

Practice address

900 Main St Ste 500
Peoria, IL 61602-5022

Phone

(309) 672-4470

Fax

(309) 672-4471

NPI assigned

Feb 14, 2023

Organization subpart

No

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

Authorized official

Name

Matthew J McMillin, MDNPI 1528021987

Title

Physician/Owner

Phone

(309) 339-3469

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Practitioners 1

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

• Matthew McMillin, MD

  • Family Medicine Physician
  • Peoria, IL
  • NPI 1528021987
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1676332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676332800000",
    "number": "1093412686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 MAIN ST STE 500",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616025022",
            "telephone_number": "309-672-4470",
            "fax_number": "309-672-4471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 MAIN ST STE 500",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616025022",
            "telephone_number": "309-672-4470",
            "fax_number": "309-672-4471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MJM FAMILY MEDICINE SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-14",
        "last_updated": "2023-02-14",
        "certification_date": "2023-02-14",
        "status": "A",
        "authorized_official_last_name": "MCMILLIN",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "309-339-3469",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Molli Mitchell
• Stephanie Mitchell, RBT
• Todd Ryan Mitchell, MD
• Andrea Jo Mitts
• Donald E Mitzelfelt, MD
• William Ted Mlotek, DC
• Muhammad Talha Moazzam, MD
• Mobile Diagnostic Services, Inc
• Robert Lincoln Mock, LCSW
• Zohra F Moeenuddin, M.D.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.