Phillip a. Immesoete MD, LTD

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

License

036042568 Issued in IL

Legal business name

PHILLIP A. IMMESOETE MD, LTD

Practice address

5401 N Knoxville Ave
Suite 406
Peoria, IL 61614-5098

Phone

(309) 691-0030

Fax

(309) 691-9262

NPI assigned

Jul 29, 2010

Organization subpart

No

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

Authorized official

Name

Phillip Arthur Immesoete, M.D.

Title

Physician

Phone

(309) 691-0030

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

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.

• Linda S Valente, NP

  • Family Nurse Practitioner
  • Peoria, IL
  • NPI 1548424948
  NPD (past)
• Cheryl M Wiemer, NP

  • Nurse Practitioner
  • Peoria, IL
  • NPI 1396877098
  NPD (past)

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

{
    "created_epoch": "1280361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280361600000",
    "number": "1245544543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5401 N KNOXVILLE AVE",
            "address_2": "SUITE 406",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616145098",
            "telephone_number": "309-691-0030",
            "fax_number": "309-691-9262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5401 N KNOXVILLE AVE",
            "address_2": "SUITE 406",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616145098",
            "telephone_number": "309-691-0030",
            "fax_number": "309-691-9262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILLIP A. IMMESOETE MD, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-29",
        "last_updated": "2010-07-29",
        "status": "A",
        "authorized_official_last_name": "IMMESOETE",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_middle_name": "ARTHUR",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "309-691-0030",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "IL",
            "license": "036042568",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036042568",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jereme Pheasant, CRNA
• Casie Phegley, M.S. CCC-SLP/L
• Amy B Pheiffer, APN
• Nora Philbin, D.O
• Angela Philips, MBBS
• Phillips Investments, LLC - Bellevue Operations Series
• Cara L Phillips, PHARMD
• Jayme Lee Phillips, PA-C
• Lisa Phillips
• Shronda Ann Phillips, APN

• Nursing Facility/Intermediate Care Facility in Peoria, IL
• Providers in Peoria, IL by specialty
• Nursing Facility/Intermediate Care Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2010; 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.