Individual provider Active NPI

Tierra Lee Weglarz, DO

  • Family Medicine Physician
  • Peoria, IL
National Provider Identifier
1154901528
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036170921 Issued in IL
Practice address
5111 N Glen Park Place Rd
Peoria, IL 61614-4675
Phone
(309) 683-5700
NPI assigned
Apr 10, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 90200000X
Family Medicine Physician 207Q00000X 036170921 IL Primary

Addresses

Primary practice location

5111 N Glen Park Place Rd
Peoria, IL 61614-4675

Mailing address

5111 N Glen Park Place Rd
Peoria, IL 61614-4675
Phone (309) 683-5700

Other names 1

  • Tierra Lee Folsom Former name

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240816001642 IL Practitioner - Family Practice 0840738266 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Pikeville, Kentucky College of Osteopathic Med, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

5111 N Glen Park Place Rd
Peoria, IL 61614-4675
Phone (309) 683-5700

Hospital & facility affiliations

  • St. Francis Medical Center Home health agency, Peoria, IL, CCN 147243
  • Saint Francis Medical Center Hospital, Peoria, IL, CCN 140067

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Osf Multi-Specialty Group CurrentSince Jul 22, 2024 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients

Locations

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

5111 N Glen Park Place Rd
Peoria, IL 61614
Phone (309) 683-5700

1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1618012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1154901528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5111 N GLEN PARK PLACE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144675",
            "telephone_number": "309-683-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5111 N GLEN PARK PLACE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144675",
            "telephone_number": "309-683-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEGLARZ",
        "first_name": "TIERRA",
        "middle_name": "LEE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-10",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": "90200000X",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036170921",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TIERRA",
            "last_name": "FOLSOM",
            "middle_name": "LEE",
            "credential": "DO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.