Active NPI
Jeanne Harris
- Pediatrics Physician
- Peoria, IL
National Provider Identifier
1295825586
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- Practice address
- 5101 N Executive Dr
Peoria, IL 61614-4868 - Phone
- (309) 692-1030
- Fax
- (309) 692-3241
- NPI assigned
- Oct 15, 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 | IL | Primary |
Addresses
Primary practice location
5101 N Executive Dr
Peoria, IL 61614-4868
Mailing address
5101 N Executive Dr
Peoria, IL 61614-4868
Phone (309) 692-1030
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 |
|---|---|---|---|
| 036-068839 | IL | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160870400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1295825586",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5101 N EXECUTIVE DR",
"city": "PEORIA",
"state": "IL",
"postal_code": "616144868",
"telephone_number": "309-692-1030",
"fax_number": "309-692-3241"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5101 N EXECUTIVE DR",
"city": "PEORIA",
"state": "IL",
"postal_code": "616144868",
"telephone_number": "309-692-1030",
"fax_number": "309-692-3241"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRIS",
"first_name": "JEANNE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-15",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.