NPIMap

Organization Active NPI

Pekin Memorial Hospital

Doing business as Pekin Hospital

  • Emergency Medical Services (Emergency Medicine) Physician
  • Pekin, IL
National Provider Identifier
1245355411
Registry record updated Jul 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X
License
0001834 Issued in IL
Legal business name
PEKIN MEMORIAL HOSPITAL
Doing business as
Pekin Hospital
Practice address
600 So 13TH Street
Pekin, IL 61554-4969
Phone
(309) 353-0406
Fax
(309) 347-1240
NPI assigned
Mar 20, 2007
Last updated
Jul 6, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
PEKIN MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 6, 2012

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

Authorized official

Name
Gary Jepson
Title
Ceo
Phone
(309) 353-0756

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X 0001834 IL Primary

Addresses

Primary practice location

600 So 13TH Street
Pekin, IL 61554-4969

Mailing address

600 So 13TH Street
Pekin, IL 61554-4969
Phone (309) 353-0406

Other names 1

  • Pekin Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040401000798 IL Part B Supplier - Clinic/Group Practice 4789676438 Receives reassigned benefits from 42 practitioners
1 other NPI on this enrollment
Practice locations: Pekin, IL

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Part of
Pekin Hospital-Crna

Practitioners & affiliated clinicians

Practitioners 43

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 43

NPI Registry JSON

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341532800000",
    "number": "1245355411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 SO 13TH STREET",
            "city": "PEKIN",
            "state": "IL",
            "postal_code": "615544969",
            "telephone_number": "309-353-0406",
            "fax_number": "309-347-1240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 SO 13TH STREET",
            "city": "PEKIN",
            "state": "IL",
            "postal_code": "615544969",
            "telephone_number": "309-353-0406",
            "fax_number": "309-347-1240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEKIN MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEKIN MEMORIAL HOSPITAL",
        "enumeration_date": "2007-03-20",
        "last_updated": "2012-07-06",
        "status": "A",
        "authorized_official_last_name": "JEPSON",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "309-353-0756"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "IL",
            "license": "0001834",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pekin Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pekin, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2012; 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.