Methodist Medical Center of Illinois

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

METHODIST MEDICAL CENTER OF ILLINOIS

Doing business as

Methodist Medical Group

Practice address

120 NE Glen Oak Ave
Suite 101
Peoria, IL 61603

Phone

(309) 671-8230

Fax

(309) 671-5118

NPI assigned

May 26, 2006

Last updated

Feb 14, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Stephen M. Cirone

Title

Regional MGR-Reimb/Rev Recognition

Phone

(309) 672-4813

Specialties & licenses 13

Addresses

Other identifiers 1

Other names 1

• Methodist Medical Group Doing business as

Medicare fee-for-service enrollment

Enrolled in IL, NC, NV, KS, TX, FL, LA, NJ, MI, IA, MO, CO, DC, NY, TN, WI, IN, CA, VA, AZ, AL, NM, MD, GA, KY, OK, WV, OH, SC30 enrollments

Enrollment records 30

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Methodist Medical Center of Illinois

  dba Carle Health Lacon

  • Rural Health Clinic/Center
  • Lacon, IL
  • NPI 1073484929

  1355259714

  Same PAC ID
• Methodist Medical Center of Illinois

  • General Acute Care Hospital
  • Peoria, IL
  • NPI 1164474755

  1355259714

  Same PAC ID
• Methodist Medical Center of Illinois

  dba Carle Health Princeville

  • Rural Health Clinic/Center
  • Princeville, IL
  • NPI 1184595027

  1355259714

  Same PAC ID
• Methodist Medical Center of Illinois

  • Emergency Care Clinic/Center
  • Peoria, IL
  • NPI 1265966048

  1355259714

  Same PAC ID
• Methodist Medical Center of Illinois

  dba Methodist Anesthesia Services

  • Anesthesiology Physician
  • Peoria, IL
  • NPI 1710198379

  1355259714

  Same PAC ID
• Methodist Medical Center of Illinois

  dba Carle Health Chillicothe

  • Rural Health Clinic/Center
  • Chillicothe, IL
  • NPI 1730050675

  1355259714

  Same PAC ID
• Methodist Medical Center of Illinois

  • Rehabilitation Hospital Unit
  • Peoria, IL
  • NPI 1982656575

  1355259714

  Same PAC ID

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Methodist Medical Center of Illinois

  • General Acute Care Hospital
  • Peoria, IL
  • NPI 1164474755

  O20031126000494, O20040315000196, O20210323001212, O20210325002199, O20210721002240, O20210804003224, O20220518001876, O20220524003288, O20220525002964, O20220830000403, O20221007002813, O20221012002902, O20221019000481, O20221110002227, O20

  Same enrollment
• Methodist Medical Center of Illinois

  • Psychiatric Hospital Unit
  • Peoria, IL
  • NPI 1275583155

  O20031126000494

  Same enrollment
• Methodist Medical Center of Illinois

  • Rehabilitation Hospital Unit
  • Peoria, IL
  • NPI 1982656575

  O20031126000494

  Same enrollment

Locations (25 of 41)

Practitioners 590

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.

• Ayla Adams, PA-C

  • Physician Assistant
  • Peoria, IL
  • NPI 1376320499
  Medicare reassignment Care Compare group NPD
• Robert Andrew Allison, PA-C

  • Physician Assistant
  • Peoria, IL
  • NPI 1275038226
  Medicare reassignment Care Compare group NPD
• Felicia Anne Clark, PA-C

  • Physician Assistant
  • Monticello, IL
  • NPI 1215556055
  Medicare reassignment Care Compare group NPD
• Jessica Gheewala, PA-C

  • Physician Assistant
  • Pekin, IL
  • NPI 1174315113
  Medicare reassignment Care Compare group NPD
• Nicole Lynn Harmon, PA

  • Physician Assistant
  • Kewanee, IL
  • NPI 1003634536
  Medicare reassignment Care Compare group NPD
• Courtney M Jaegle, PA

  • Physician Assistant
  • Peoria, IL
  • NPI 1013196682
  Medicare reassignment Care Compare group NPD
• Angela Poblocki

  • Physician Assistant
  • Bartonville, IL
  • NPI 1982133294
  Medicare reassignment Care Compare group NPD
• Svyatoslav Puyat

  • Physician Assistant
  • Peoria, IL
  • NPI 1194402636
  Medicare reassignment Care Compare group NPD
• Dalton Rea

  • Physician Assistant
  • Peoria, IL
  • NPI 1336974476
  Medicare reassignment Care Compare group NPD
• Ashley Rodriguez

  • Physician Assistant
  • Peoria, IL
  • NPI 1780427005
  Medicare reassignment Care Compare group NPD
• Brian A Schrock, PA

  • Physician Assistant
  • Chillicothe, IL
  • NPI 1356732101
  Medicare reassignment Care Compare group NPD
• Alesia Svymbersky, PA-C

  • Surgical Physician Assistant
  • Peoria, IL
  • NPI 1235273574
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581638400000",
    "number": "1184670663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5100 RELIABLE PKWY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606860051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 NE GLEN OAK AVE",
            "address_2": "SUITE 101",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "61603",
            "telephone_number": "309-671-8230",
            "fax_number": "309-671-5118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METHODIST MEDICAL CENTER OF ILLINOIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-26",
        "last_updated": "2020-02-14",
        "certification_date": "2020-02-14",
        "status": "A",
        "authorized_official_last_name": "CIRONE",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "REGIONAL MGR-REIMB/REV RECOGNITION",
        "authorized_official_telephone_number": "309-672-4813"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207VM0101X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Maternal & Fetal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PPO",
            "identifier": "7215059",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Methodist Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Methodist (Unitypoint Health Methodist)
• Methodist Medical Center of Illinois (Carle Health Home Dialysis Clinic)
• Methodist Medical Center of Illinois
• Methodist Medical Center of Illinois
• Methodist Medical Center of Illinois
• Methodist Medical Center of Illinois
• Methodist Medical Center of Illinois
• Methodist Medical Center of Illinois (Methodist Emergency Services)
• Methodist Medical Center of Illinois (Carle Health Outpatient Dialysis Center)
• Methodist Medical Center of Illinois

• Family Medicine Physician in Peoria, IL
• Providers in Peoria, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.