Active NPI
Jodie Dewey, MD
- Pediatrics Physician
- Bloomington, IL
National Provider Identifier
1275559270
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 036088592
- Practice address
- 302 Saint Joseph Dr
Bloomington, IL 61701-3506 - Phone
- (309) 664-3100
- Fax
- (309) 664-3027
- NPI assigned
- Jul 14, 2006
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 036088592 | IL | Primary |
Addresses
Primary practice location
302 Saint Joseph Dr
Bloomington, IL 61701-3506
Mailing address
302 Saint Joseph Dr
Bloomington, IL 61701-3506
Phone (309) 664-3100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| IL2613 | Other | MEDICARE GROUP # |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398124800000",
"number": "1275559270",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "302 SAINT JOSEPH DR",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617013506",
"telephone_number": "309-664-3100",
"fax_number": "309-664-3027"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "302 SAINT JOSEPH DR",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617013506",
"telephone_number": "309-664-3100",
"fax_number": "309-664-3027"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEWEY",
"first_name": "JODIE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-14",
"last_updated": "2014-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IL",
"license": "036088592",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP #",
"identifier": "IL2613",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.