Individual provider Active NPI

Trina Croland

  • Pediatrics Physician
  • Peoria, IL
National Provider Identifier
1205936879
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Practice address
420 NE Glen Oak Ave
Peoria, IL 61603-3105
Phone
(309) 627-5673
Fax
(309) 683-5669
NPI assigned
Sep 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X IL Primary

Addresses

Primary practice location

420 NE Glen Oak Ave
Peoria, IL 61603-3105

Mailing address

420 NE Glen Oak Ave
Peoria, IL 61603-3105
Phone (309) 627-5673

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
I20050825000208 IL Practitioner - Pediatric Medicine 3274564620 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-104126ILMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Osf Multi-Specialty Group CurrentSince Jan 1, 2016 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
The Board of Trustees of the University of Illinois CurrentSince Aug 28, 2018 Accepting new patients
Board of Trustees of the University of Illinois Pediatrics CurrentSince Aug 28, 2018 Accepting new patients
The Board of Trustees of the University of Illinois Current Accepting new patients

Locations

7694 Solutions Ctr
Chicago, IL 60677

1614 E Norris Dr
Ottawa, IL 61350
Phone (815) 433-1010

1 Illini Dr
Peoria, IL 61605
Phone (309) 671-3000

530neglen Oak Ave
Peoria, IL 61637
Phone (309) 692-5393

530 NE Glen Oak Ave
Peoria, IL 61637
Phone (309) 655-2553

420 NE Glen Oak Ave
Peoria, IL 61603
Phone (309) 655-2343

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

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1159056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1205936879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616033105",
            "telephone_number": "309-627-5673",
            "fax_number": "309-683-5669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616033105",
            "telephone_number": "309-627-5673",
            "fax_number": "309-683-5669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROLAND",
        "first_name": "TRINA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.