Active NPI
Peggy L Bandy, M.D.
- Family Medicine Physician
- Chicago, IL
National Provider Identifier
1265414700
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 036100321
- Practice address
- 1431 N Western Ave Ste 401
Chicago, IL 60622-1774 - Phone
- (312) 491-5086
- Fax
- (312) 491-5485
- NPI assigned
- Nov 18, 2005
- Last updated
- Dec 30, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036100321 | IL | Primary |
Addresses
Primary practice location
1431 N Western Ave Ste 401
Chicago, IL 60622-1774
Mailing address
1431 N Western Ave Suite 401
Chicago, IL 60622-1774
Phone (312) 491-5086
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036100321 | Medicaid | IL | |
| 036100321 | Other | IL | IL STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036100321 | IL | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gibson Community Hospital Association | Past | Accepting new patients | |
| The Board of Trustees of the University of Illinois | Family Medicine | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Gibson Area Hospital and Health Services
- Critical Access Hospital
- Gibson City, IL
- NPI 1114935681
-
dba Uic Merit
- Pediatrics Physician
- Rockford, IL
- NPI 1972541902
Family Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1325203200000",
"number": "1265414700",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1431 N WESTERN AVE SUITE 401",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606221774",
"telephone_number": "312-491-5086",
"fax_number": "312-491-5485"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1431 N WESTERN AVE STE 401",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606221774",
"telephone_number": "312-491-5086",
"fax_number": "312-491-5485"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BANDY",
"first_name": "PEGGY",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-11-18",
"last_updated": "2011-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "036100321",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036100321",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IL STATE LICENSE",
"identifier": "036100321",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.