Active NPI
Matthew T Bramlet, MD
- Pediatric Cardiology Physician
- Peoria, IL
National Provider Identifier
1164689428
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Cardiology Physician
- License
- 036-123369
- Practice address
- 420 NE Glen Oak Ave
Suite 301
Peoria, IL 61603-3105 - Phone
- (309) 655-3453
- Fax
- (309) 655-3410
- NPI assigned
- May 22, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Cardiology Physician | 2080P0202X | 036-123369 | IL | Primary |
Addresses
Primary practice location
420 NE Glen Oak Ave
Suite 301
Peoria, IL 61603-3105
Mailing address
420 NE Glen Oak Ave
Suite 301
Peoria, IL 61603-3105
Phone (309) 655-3453
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 216946 | Other | IL | MEDICARE GROUP PTAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-123369 | IL | MD | Pediatric Cardiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gibson Community Hospital Association | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Critical Access Hospital
- Gibson City, IL
- NPI 1114935681
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211414400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1293408000000",
"number": "1164689428",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "420 NE GLEN OAK AVE",
"address_2": "SUITE 301",
"city": "PEORIA",
"state": "IL",
"postal_code": "616033105",
"telephone_number": "309-655-3453",
"fax_number": "309-655-3410"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 NE GLEN OAK AVE",
"address_2": "SUITE 301",
"city": "PEORIA",
"state": "IL",
"postal_code": "616033105",
"telephone_number": "309-655-3453",
"fax_number": "309-655-3410"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRAMLET",
"first_name": "MATTHEW",
"middle_name": "T",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-05-22",
"last_updated": "2010-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0202X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Cardiology",
"state": "IL",
"license": "036-123369",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP PTAN",
"identifier": "216946",
"state": "IL"
}
],
"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 Dec 27, 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.