Individual provider Active NPI

Stephanie Perez

  • Physician Assistant
  • Peoria, IL
National Provider Identifier
1255067823
Registry record updated Jun 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
6000 N Allen Rd
Peoria, IL 61614-3294
Phone
(309) 691-1400
NPI assigned
Jul 26, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 085010279 IL
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

6000 N Allen Rd
Peoria, IL 61614-3294

Mailing address

6000 N Allen Rd
Peoria, IL 61614-3294
Phone (306) 691-1400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, OR2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240620004160 IL Practitioner - Physician Assistant 1254874027 Reassigns benefits to 1 organization
I20251215000913 OR Practitioner - Physician Assistant 1254874027 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bay Area Hospital DistrictGroup PAC ID 2163331000, 117 clinicians
Midwest Orthopaedic Center S CGroup PAC ID 8022917715, 45 clinicians

Practice addresses (Care Compare)

1775 Thompson Rd
Coos Bay, OR 97420-2125
Phone (541) 269-8280

6000 N Allen Rd
Peoria, IL 61614-3294
Phone (309) 691-1400

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Bay Area Hospital District CurrentSince Oct 14, 2025 Accepting new patients
Bay Area Hospital District CurrentSince Oct 14, 2025 Accepting new patients

Locations

Dept LA 25339
Pasadena, CA 91185

2650 N 17th St
Coos Bay, OR 97420
Phone (541) 267-5411

1775 Thompson Rd
Coos Bay, OR 97420
Phone (541) 269-8090

Organizations & group practices 3

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1658793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750291200000",
    "number": "1255067823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6000 N ALLEN RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616143294",
            "telephone_number": "306-691-1400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6000 N ALLEN RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616143294",
            "telephone_number": "309-691-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEREZ",
        "first_name": "STEPHANIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-26",
        "last_updated": "2025-06-19",
        "certification_date": "2025-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IL",
            "license": "085010279",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.