NPIMap

Organization Active NPI

The Bleeding and Clotting Disorders Institute

  • Clinic/Center
  • Peoria, IL
National Provider Identifier
1134424633
Registry record updated Jul 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
036101239 Issued in IL
Legal business name
THE BLEEDING AND CLOTTING DISORDERS INSTITUTE
Practice address
427 W Northmoor Rd
Peoria, IL 61614-3542
Phone
(309) 692-5337
Fax
(309) 693-3913
NPI assigned
Jan 14, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2021

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

Authorized official

Name
Mr. Michael D Tarantino, M.D.NPI 1396731063
Title
Medical Director
Phone
(309) 692-5337

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 036101239 IL Primary

Addresses

Primary practice location

427 W Northmoor Rd
Peoria, IL 61614-3542

Mailing address

427 W Northmoor Rd
Peoria, IL 61614-3542
Phone (309) 692-5337

Other identifiers 2

IdentifierTypeStateIssuer
398680716MedicaidIL
7225372OtherBCBS OF IL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110426000500 IL Part B Supplier - Clinic/Group Practice 6608051230 Receives reassigned benefits from 13 practitioners
1 other NPI on this enrollment
Practice locations: Peoria, IL

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1294963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627603200000",
    "number": "1134424633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "427 W NORTHMOOR RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616143542",
            "telephone_number": "309-692-5337",
            "fax_number": "309-693-3913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "427 W NORTHMOOR RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616143542",
            "telephone_number": "309-692-5337",
            "fax_number": "309-693-3913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE BLEEDING AND CLOTTING DISORDERS INSTITUTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-14",
        "last_updated": "2021-07-30",
        "certification_date": "2021-06-29",
        "status": "A",
        "authorized_official_last_name": "TARANTINO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "309-692-5337",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "IL",
            "license": "036101239",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "398680716",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF IL",
            "identifier": "7225372",
            "state": null
        }
    ],
    "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 Jul 30, 2021; 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.