NPIMap

Individual provider Active NPI

Vijay Laxmi Misra, M.D.

  • Gastroenterology Physician
  • Bloomington, IL
National Provider Identifier
1164475877
Registry record updated Jun 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
036126566 Issued in IL
Practice address
1709 Tullamore Ave Ste C
Bloomington, IL 61704-9603
Phone
(309) 454-5900
Fax
(309) 454-2820
NPI assigned
May 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 036126566 IL Primary

Addresses

Primary practice location

1709 Tullamore Ave Ste C
Bloomington, IL 61704-9603

Mailing address

1709 Tullamore Ave Ste C
Bloomington, IL 61704-9603
Phone (309) 454-5900

Other identifiers 1

IdentifierTypeStateIssuer
036126566MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110107000891 IL Practitioner - GastroenterologyPractitioner - Internal Medicine 3971545823 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Illinois Gastroenterology Group LLCGroup PAC ID 5193857423, 116 clinicians

Practice addresses (Care Compare)

1302 Franklin Ave
Suite 4800
Normal, IL 61761-3595
Phone (309) 454-5900

Hospital & facility affiliations

  • St Joseph Medical Center Hospital, Bloomington, IL, CCN 140162
  • Carle Eureka Hospital Hospital, Eureka, IL, CCN 141309
  • Carle Bromenn Medical Center Hospital, Normal, IL, CCN 140127
  • Saint James Hospital Hospital, Pontiac, IL, CCN 140161

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy158
Upper gastrointestinal (GI) endoscopy for acid reflux217

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Elgin Gastroenterology Endoscopy Center LLC Current Accepting new patients
Illinois Gastroenterology Group, LLC Gastroenterology CurrentSince Feb 1, 2022 Accepting new patients
Northwest Gastroenterologists SC Current Accepting new patients
Elgin Gastroenterology SC Gastroenterology Current Accepting new patients
Carle Eureka Hospital CurrentSince Jan 31, 2026 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
Major Hospital Past Accepting new patients
Southside Emergency Associates Past Accepting new patients
Eastland Medical Plaza Surgicenter, LLC Past Accepting new patients

Locations

1709 Tullamore Ave
Ste C
Bloomington, IL 61704
Phone (309) 454-5900

1505 Eastland Dr
Ste 2000
Bloomington, IL 61701

1228 Towanda Ave
Ste 1
Bloomington, IL 61701
Phone (309) 454-5900

745 Fletcher Dr
Ste 202
Elgin, IL 60123
Phone (855) 483-7362

101 S Major St
Eureka, IL 61530
Phone (309) 268-2172

2550 W Algonquin Rd
Lk in the Hls, IL 60156
Phone (847) 458-1246

1302 Franklin Ave
Ste 4800
Normal, IL 61761
Phone (309) 454-5900

Organizations & group practices 9

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 4

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": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782432000000",
    "number": "1164475877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1709 TULLAMORE AVE STE C",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617049603",
            "telephone_number": "309-454-5900",
            "fax_number": "309-454-2820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1709 TULLAMORE AVE STE C",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617049603",
            "telephone_number": "309-454-5900",
            "fax_number": "309-454-2820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MISRA",
        "first_name": "VIJAY LAXMI",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-17",
        "last_updated": "2026-06-26",
        "certification_date": "2026-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IL",
            "license": "036126566",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036126566",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IL

Sources for this page

Verify at the official NPI Registry.