Individual provider Active NPI

Matthew Culp

  • Family Nurse Practitioner
  • Peoria, IL
National Provider Identifier
1285142281
Registry record updated Jan 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209017120 Issued in IL
Practice address
112 NE Crescent Ave
Peoria, IL 61606-1901
Phone
(309) 672-4670
NPI assigned
Jan 12, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 12, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209017120 IL Primary

Addresses

Primary practice location

112 NE Crescent Ave
Peoria, IL 61606-1901

Mailing address

112 NE Crescent Ave
Peoria, IL 61606-1901
Phone (309) 672-4670

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180313001604 IL Practitioner - Nurse Practitioner 3870855729 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carle Health Care IncorporatedGroup PAC ID 3577515774, 1,592 clinicians
Methodist Medical Center of IllinoisGroup PAC ID 1355259714, shared by 8 NPIs, 387 clinicians

Practice addresses (Care Compare)

112 NE Crescent Ave
Peoria, IL 61606-1901
Phone (309) 672-4670

221 NE Glen Oak
Peoria, IL 61636
Phone (309) 672-5522

221 NE Glen Oak Ave
Peoria, IL 61636-0001

600 S 13TH St
Pekin, IL 61554-4936

611 W Park St
Urbana, IL 61801-2501
Phone (888) 712-2753

900 Main St
Peoria, IL 61602-1060

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209017120ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Proctor Health Systems Current Accepting new patients
Methodist Medical Center of Illinois Family CurrentSince Jan 15, 2018 Accepting new patients
Proctor Health Systems CurrentSince Jan 15, 2018 Accepting new patients
Methodist Medical Center of Illinois CurrentSince Jan 15, 2018 Accepting new patients
Proctor Health Systems CurrentSince Jan 15, 2018 Accepting new patients
Carle Health Care Incorporated CurrentSince Jan 1, 2026 Accepting new patients
Methodist Medical Center of Illinois Current Accepting new patients
Pekin Prohealth Inc CurrentSince Jan 15, 2018 Accepting new patients

Locations

600 S 13th St
Pekin, IL 61554
Phone (309) 347-1151

112 NE Crescent Ave
Peoria, IL 61606
Phone (309) 680-2402

5401 N Knoxville Ave
Ste 400
Peoria, IL 61614
Phone (309) 691-6610

120 NE Glen Oak Ave
Ste 400
Peoria, IL 61603
Phone (309) 671-3519

221 NE Glen Oak Ave
Peoria, IL 61636
Phone (309) 672-4281

815 Main St
Ste A
Peoria, IL 61602
Phone (309) 672-4986

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1515715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1515715200000",
    "number": "1285142281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 NE CRESCENT AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616061901",
            "telephone_number": "309-672-4670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 NE CRESCENT AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616061901",
            "telephone_number": "309-672-4670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CULP",
        "first_name": "MATTHEW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-01-12",
        "last_updated": "2018-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209017120",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.