NPIMap

Organization Active NPI

Illinois Gastroenterology Institute, PLLC

  • Gastroenterology Physician
  • Peoria, IL
National Provider Identifier
1275575706
Registry record updated Aug 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
042006270 Issued in IL
Legal business name
ILLINOIS GASTROENTEROLOGY INSTITUTE, PLLC
Practice address
1001 Main St
Suite 500a
Peoria, IL 61606-1907
Phone
(309) 672-4980
Fax
(309) 671-2944
NPI assigned
Jun 11, 2006
Last updated
Aug 17, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2020

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

Authorized official

Name
Mike Shadley
Title
Administrator
Phone
(309) 672-4980

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 042006270 IL Primary

Addresses

Primary practice location

1001 Main St
Suite 500a
Peoria, IL 61606-1907

Mailing address

PO Box 365
Morton, IL 61550-0365
Phone (309) 672-4980

Other identifiers 2

IdentifierTypeStateIssuer
07215152OtherILBLUE CROSS
CE0700OtherILRAILROAD MEDICARE

Other names 1

  • Gastroenterology, Ltd Former legal business name

National Provider Directory

National Provider Directory

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597622400000",
    "number": "1275575706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 365",
            "city": "MORTON",
            "state": "IL",
            "postal_code": "615500365",
            "telephone_number": "309-672-4980",
            "fax_number": "309-671-2944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 MAIN ST",
            "address_2": "SUITE 500A",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616061907",
            "telephone_number": "309-672-4980",
            "fax_number": "309-671-2944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS GASTROENTEROLOGY INSTITUTE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-11",
        "last_updated": "2020-08-17",
        "certification_date": "2020-08-17",
        "status": "A",
        "authorized_official_last_name": "SHADLEY",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "309-672-4980"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IL",
            "license": "042006270",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "07215152",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CE0700",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gastroenterology, Ltd",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Gastroenterology, Ltd",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Peoria, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.