NPIMap

Organization Active NPI

University of Illinois

Doing business as Medical Service Plan at Peoria

  • Pediatric Neurodevelopmental Disabilities Physician
  • Peoria, IL
National Provider Identifier
1174596225
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Neurodevelopmental Disabilities PhysicianTaxonomy code 2080P0008X
Legal business name
UNIVERSITY OF ILLINOIS
Doing business as
Medical Service Plan at Peoria
Practice address
515 NE Glen Oak Ave
Pediatric Neurology
Peoria, IL 61603-3165
Phone
(309) 624-9844
NPI assigned
Feb 9, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
William R Nicholas, PHD
Title
Executive Director of MSP
Phone
(312) 413-0573

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Neurodevelopmental Disabilities Physician 2080P0008X IL Primary

Addresses

Primary practice location

515 NE Glen Oak Ave
Pediatric Neurology
Peoria, IL 61603-3165

Mailing address

1 Illini Dr
Peoria, IL 61605-2576
Phone (309) 671-8503

Other identifiers 1

IdentifierTypeStateIssuer
07215036OtherILBCBS

Other names 1

  • Medical Service Plan at Peoria Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Uic Dept of Pathology122 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

515 NE Glen Oak Ave
Peoria, IL 61603
Phone (309) 624-7777

Practitioners & affiliated clinicians

Practitioners 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1139443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1174596225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 ILLINI DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616052576",
            "telephone_number": "309-671-8503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 NE GLEN OAK AVE",
            "address_2": "PEDIATRIC NEUROLOGY",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616033165",
            "telephone_number": "309-624-9844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF ILLINOIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "NICHOLAS",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR OF MSP",
        "authorized_official_telephone_number": "312-413-0573",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "2080P0008X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neurodevelopmental Disabilities",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "07215036",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Service Plan at Peoria",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Aug 22, 2020; 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.