Lori L Pegram, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036072679 Issued in IL

Practice address

302 Saint Joseph Dr
Bloomington, IL 61701-3506

Phone

(309) 664-3100

Fax

(309) 664-3027

NPI assigned

Aug 9, 2006

Last updated

Apr 22, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Gibson Community Hospital Association

  dba Gibson Area Hospital and Health Services

  • Critical Access Hospital
  • Gibson City, IL
  • NPI 1114935681
  NPD (past)

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398124800000",
    "number": "1215947171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 SAINT JOSEPH DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617013506",
            "telephone_number": "309-664-3100",
            "fax_number": "309-664-3027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 SAINT JOSEPH DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617013506",
            "telephone_number": "309-664-3100",
            "fax_number": "309-664-3027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEGRAM",
        "first_name": "LORI",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-09",
        "last_updated": "2014-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036072679",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "IL2613",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paul Pedersen
• Pediatric Dental Associates of McLean County, Inc
• Michael Robert Peffer, DC
• Edward W Pegg III, MD
• Edward W Pegg IV, M.D.
• Julie Ann Peloza
• Leesha Peoples, CRNA
• Hollie M. Perez
• Christopher G Perkins, L.C.P.C.
• Persimmon Tree Counseling, LLC

• Internal Medicine Physician in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2014; 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.