Active NPI
Proctor Health Systems
- Primary Care Clinic/Center
- Peoria, IL
National Provider Identifier
1306890108
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Primary Care Clinic/Center
- Legal business name
- PROCTOR HEALTH SYSTEMS
- Practice address
- 5401 N Knoxville Ave
Suite 300
Peoria, IL 61614-5098 - Phone
- (309) 683-1200
- Fax
- (309) 691-1705
- NPI assigned
- May 19, 2006
- Organization subpart
- Yes
- Parent organization
- PROCTOR HEALTH SYSTEMS
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Carrie Chiaravalle
- Title
- Director
- Phone
- (309) 689-6049
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | Primary |
Addresses
Primary practice location
5401 N Knoxville Ave
Suite 300
Peoria, IL 61614-5098
Mailing address
5401 N Knoxville Ave
Suite 209
Peoria, IL 61614-5098
Phone (309) 689-6049
Other names 1
- DENNIS CRNKOVICH MD, ROBERT MEISTER MD
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
Other NPIs on the same Medicare enrollment 10
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Part of
- Rebecca Knight MD
Locations
5401 N Knoxville Ave
Ste 300
Peoria, IL 61614
Phone (309) 671-2197
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Medicine Physician
- Peoria, IL
- NPI 1245223130
-
- Cardiovascular Disease Physician
- Peoria, IL
- NPI 1548440803
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147996800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1186444800000",
"number": "1306890108",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5401 N KNOXVILLE AVE",
"address_2": "SUITE 209",
"city": "PEORIA",
"state": "IL",
"postal_code": "616145098",
"telephone_number": "309-689-6049",
"fax_number": "309-689-6092"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5401 N KNOXVILLE AVE",
"address_2": "SUITE 300",
"city": "PEORIA",
"state": "IL",
"postal_code": "616145098",
"telephone_number": "309-683-1200",
"fax_number": "309-691-1705"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PROCTOR HEALTH SYSTEMS",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "PROCTOR HEALTH SYSTEMS",
"enumeration_date": "2006-05-19",
"last_updated": "2007-08-07",
"status": "A",
"authorized_official_last_name": "CHIARAVALLE",
"authorized_official_first_name": "CARRIE",
"authorized_official_title_or_position": "DIRECTOR",
"authorized_official_telephone_number": "309-689-6049"
},
"taxonomies": [
{
"code": "261QP2300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Primary Care",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "DENNIS CRNKOVICH MD, ROBERT MEISTER MD",
"code": "3",
"type": "Doing Business As"
}
]
}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 7, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.