Individual provider Active NPI

Beth A Speckhart, APN

  • Pediatric Oncology Clinical Nurse Specialist
  • Peoria, IL
National Provider Identifier
1154751436
Registry record updated Nov 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Oncology Clinical Nurse SpecialistTaxonomy code 364SX0204X
License
209.001360041.253087 Issued in IL
Practice address
530 NE Glen Oak Ave
Peoria, IL 61637-0001
Phone
(309) 624-4945
Fax
(309) 624-4289
NPI assigned
Nov 22, 2013
Last updated
Nov 22, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Oncology Clinical Nurse Specialist 364SX0204X 209.001360041.253087 IL Primary

Addresses

Primary practice location

530 NE Glen Oak Ave
Peoria, IL 61637-0001

Mailing address

530 NE Glen Oak Ave
Peoria, IL 61637-0001
Phone (309) 624-4945

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
I20140908001294 IL Practitioner - Certified Clinical Nurse Specialist (CNS) 7113146002 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
93.28 of 100Reported as group
Quality
73.53
Promoting interoperability
100
Improvement activities
40
Cost
70.73

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209.001360041.253087ILMDPediatric Oncology Clinical Nurse Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
The Board of Trustees of the University of Illinois CurrentSince Nov 18, 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 Nov 18, 2014 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

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

Organizations & group practices 4

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": "1385078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1385078400000",
    "number": "1154751436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616370001",
            "telephone_number": "309-624-4945",
            "fax_number": "309-624-4289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616370001",
            "telephone_number": "309-624-4945",
            "fax_number": "309-624-4289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPECKHART",
        "first_name": "BETH",
        "middle_name": "A",
        "name_prefix": "Mrs.",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-22",
        "last_updated": "2013-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SX0204X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Oncology, Pediatrics",
            "state": "IL",
            "license": "209.001360041.253087",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.