NPIMap

Organization Active NPI

Illinois Cardiac Surgery Associates SC

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Peoria, IL
National Provider Identifier
1114018439
Registry record updated May 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
Legal business name
ILLINOIS CARDIAC SURGERY ASSOCIATES SC
Practice address
515 NE Glen Oak
Suite 105
Peoria, IL 61603-3167
Phone
(309) 674-2002
Fax
(309) 624-9898
NPI assigned
Sep 28, 2006
Last updated
May 6, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2014

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

Authorized official

Name
Mr. Dale M Geiss, MD
Title
President
Phone
(309) 674-2002

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X IL Primary

Addresses

Primary practice location

515 NE Glen Oak
Suite 105
Peoria, IL 61603-3167

Mailing address

515 NE Glen Oak
Suite 105
Peoria, IL 61603-3167
Phone (309) 674-2002

Other identifiers 1

IdentifierTypeStateIssuer
07215075OtherILBLUE SHEILD

National Provider Directory

National Provider Directory

Locations

765 N Kellogg St
Galesburg, IL 61401
Phone (309) 343-0160

515 NE Glen Oak Ave
Ste 105
Peoria, IL 61603
Phone (309) 674-2002

515 NE Glen Oak Ave
Ste 202
Peoria, IL 61603
Phone (309) 624-4455

Practitioners & affiliated clinicians

Practitioners 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399334400000",
    "number": "1114018439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 NE GLEN OAK",
            "address_2": "SUITE 105",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616033167",
            "telephone_number": "309-674-2002",
            "fax_number": "309-624-9898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 NE GLEN OAK",
            "address_2": "SUITE 105",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616033167",
            "telephone_number": "309-674-2002",
            "fax_number": "309-624-9898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS CARDIAC SURGERY ASSOCIATES SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2014-05-06",
        "status": "A",
        "authorized_official_last_name": "GEISS",
        "authorized_official_first_name": "DALE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "309-674-2002",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHEILD",
            "identifier": "07215075",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2014; 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.