Primary Care Specialists, LLC

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

036121501 Issued in IL

Legal business name

PRIMARY CARE SPECIALISTS, LLC

Practice address

2 Airline Dr
Suite 500
Bloomington, IL 61704-3433

Phone

(636) 579-6778

NPI assigned

May 25, 2009

Organization subpart

No

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

Authorized official

Name

Srivalli Vegi, M.D.

Title

Owner

Phone

(636) 579-6778

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1243209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271289600000",
    "number": "1154556843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 AIRLINE DR",
            "address_2": "SUITE 500",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617043433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 AIRLINE DR",
            "address_2": "SUITE 500",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617043433",
            "telephone_number": "636-579-6778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE SPECIALISTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-25",
        "last_updated": "2010-04-15",
        "status": "A",
        "authorized_official_last_name": "VEGI",
        "authorized_official_first_name": "SRIVALLI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "636-579-6778",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036121501",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "IL",
            "license": "036121501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Geriatric Medicine (Internal Medicine) Physician in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Geriatric Medicine (Internal Medicine) Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2010; 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.