Individual provider Active NPI

Tammy Burtch

  • Clinical Social Worker
  • Peoria, IL
National Provider Identifier
1245748920
Registry record updated Jan 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149018568 Issued in IL
Practice address
900 Main St Ste 400
Peoria, IL 61602-1060
Phone
(309) 672-3100
NPI assigned
Jan 17, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 149018568 IL Primary

Addresses

Primary practice location

900 Main St Ste 400
Peoria, IL 61602-1060

Mailing address

900 Main St Ste 400
Peoria, IL 61602-1060
Phone (309) 672-3100

Other identifiers 1

IdentifierTypeStateIssuer
149018568OtherILLICENSE

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180207000069 IL Practitioner - Clinical Social Worker 7416217732 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Phoenix Wellness, LLCGroup PAC ID 4183997679, 4 clinicians

Practice addresses (Care Compare)

2020 W War Memorial Dr
Suite 304
Peoria, IL 61614-6730
Phone (309) 928-7717

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Proctor Health Systems CurrentSince Jan 1, 2018 Accepting new patients
Methodist Medical Center of Illinois CurrentSince Jan 1, 2018 Accepting new patients
Methodist Medical Center of Illinois Current Accepting new patients
Phoenix Wellness, LLC Clinical CurrentSince Sep 21, 2022 Accepting new patients
Methodist Medical Center of Illinois CurrentSince Jan 1, 2018 Accepting new patients
Proctor Health Systems CurrentSince Jan 1, 2018 Accepting new patients
Proctor Health Systems Current Accepting new patients

Locations

7820 N University St
Ste 204
Peoria, IL 61614
Phone (309) 589-0888

815 Main St
Ste A
Peoria, IL 61602
Phone (309) 672-4986

221 NE Glen Oak Ave
Peoria, IL 61636
Phone (309) 672-4281

2020 W War Memorial Dr
Ste 304
Peoria, IL 61614
Phone (309) 689-6246

120 NE Glen Oak Ave
Ste 400
Peoria, IL 61603
Phone (309) 671-3519

5401 N Knoxville Ave
Ste 400
Peoria, IL 61614
Phone (309) 691-6610

112 NE Crescent Ave
Peoria, IL 61606
Phone (309) 680-2402

900 Main St
Ste 400
Peoria, IL 61602
Phone (309) 671-3100

Organizations & group practices 7

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": "1516147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516147200000",
    "number": "1245748920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 MAIN ST STE 400",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616021060",
            "telephone_number": "309-672-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 MAIN ST STE 400",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616021060",
            "telephone_number": "309-672-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURTCH",
        "first_name": "TAMMY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-17",
        "last_updated": "2018-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149018568",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "149018568",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.