NPIMap

Organization Active NPI

Premier Medical Group, LLC

  • Orthopaedic Surgery Physician
  • Normal, IL
National Provider Identifier
1275825432
Registry record updated May 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
36-098056 Issued in IL
Legal business name
PREMIER MEDICAL GROUP, LLC
Practice address
2005 Jacobssen Dr
Suite a
Normal, IL 61761-6287
Phone
(309) 807-2233
Fax
(309) 888-3174
NPI assigned
May 6, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2011

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

Authorized official

Name
Mrs. Judy M Matens
Title
Credentialling Administrator
Phone
(309) 662-6200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X 36-098056 IL Primary

Addresses

Primary practice location

2005 Jacobssen Dr
Suite a
Normal, IL 61761-6287

Mailing address

2005 Jacobssen Dr
Suite a
Normal, IL 61761-6287
Phone (309) 807-2233

Other names 1

  • Premier Orthopedics, LLC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Premier Medical Group LLC12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1304640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304640000000",
    "number": "1275825432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2005 JACOBSSEN DR",
            "address_2": "SUITE A",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617616287",
            "telephone_number": "309-807-2233",
            "fax_number": "309-888-3174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2005 JACOBSSEN DR",
            "address_2": "SUITE A",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617616287",
            "telephone_number": "309-807-2233",
            "fax_number": "309-888-3174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-06",
        "last_updated": "2011-05-06",
        "status": "A",
        "authorized_official_last_name": "MATENS",
        "authorized_official_first_name": "JUDY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALLING ADMINISTRATOR",
        "authorized_official_telephone_number": "309-662-6200",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "IL",
            "license": "36-098056",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Orthopedics, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Normal, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 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.

Verify at the official NPI Registry.