Kevin J Schrock, O. T.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

111 W Washington St Ste 230
East Peoria, IL 61611-2560

Phone

(309) 347-5579

Fax

(309) 347-4264

NPI assigned

Jan 15, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720310400000",
    "number": "1255482543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 W WASHINGTON ST STE 230",
            "city": "EAST PEORIA",
            "state": "IL",
            "postal_code": "616112560",
            "telephone_number": "309-347-5579",
            "fax_number": "309-347-4264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 W WASHINGTON ST STE 230",
            "city": "EAST PEORIA",
            "state": "IL",
            "postal_code": "616112560",
            "telephone_number": "309-347-5579",
            "fax_number": "309-347-4264"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2338 W Sud Pkwy",
            "address_2": "Ste 3100",
            "address_purpose": "LOCATION",
            "city": "Peoria",
            "state": "IL",
            "postal_code": "616157483",
            "country_code": "US",
            "telephone_number": "309-693-9189",
            "fax_number": "309-693-9946",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SCHROCK",
        "first_name": "KEVIN",
        "middle_name": "J",
        "credential": "O. T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-15",
        "last_updated": "2024-07-07",
        "certification_date": "2024-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": "056005963",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P01030410",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in East Peoria, IL
• Providers in East Peoria, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.