NPIMap

Individual provider Active NPI

Gueorgui S Gueorguiev, M.D.

  • Family Medicine Physician
  • Ottawa, IL
National Provider Identifier
1356336952
Registry record updated Mar 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036105269 Issued in IL
Practice address
1614 E Norris Dr
Ottawa, IL 61350-3681
Phone
(815) 433-1010
Fax
(815) 433-0067
NPI assigned
Sep 20, 2005
Last updated
Mar 25, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036105269 IL Primary

Addresses

Primary practice location

1614 E Norris Dr
Ottawa, IL 61350-3681

Mailing address

1614 E Norris Dr
Ottawa, IL 61350-3681
Phone (815) 433-1010

Other identifiers 1

IdentifierTypeStateIssuer
127259OtherHEALTH ALLIANCE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040512001483 IL Practitioner - Family Practice 4981694064 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mendota Community HospitalGroup PAC ID 2264335777, 51 clinicians

Practice addresses (Care Compare)

102 11TH St
Marseilles, IL 61341-1048
Phone (815) 795-5400

1100 E Norris Dr
Ottawa, IL 61350-1604
Phone (815) 433-3100

1401 E 12TH St
Mendota, IL 61342-9216
Phone (815) 539-7461

1614 E Norris Dr
Osf Healthcare Medical Group Ottawa
Ottawa, IL 61350-3681
Phone (815) 433-1010

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Mendota Community Hospital CurrentSince Dec 15, 2015 Accepting new patients
Ottawa Regional Hospital & Healthcare Center CurrentSince Dec 1, 2022 Accepting new patients
Mendota Community Hospital Family Medicine CurrentSince Dec 15, 2015 Accepting new patients
Ottawa Regional Hospital & Healthcare Center Family Medicine CurrentSince Dec 1, 2022 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Jan 1, 2016 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
Ottawa Regional Hospital & Healthcare Center Past Accepting new patients
Copley Memorial Hospital, Inc. Family Medicine PastSince Jul 1, 2023 Accepting new patients

Locations

102 11th St
Marseilles, IL 61341
Phone (815) 795-5400

1401 E 12th St
Mendota, IL 61342
Phone (815) 539-7461

1404 Washington St
Mendota, IL 61342
Phone (815) 538-1825

1050 E Norris Dr
Ste 3A
Ottawa, IL 61350
Phone (815) 431-5746

1100 E Norris Dr
Ottawa, IL 61350
Phone (815) 416-1224

1614 E Norris Dr
Ottawa, IL 61350
Phone (815) 433-1010

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Osf Healthcare - Medical Group - MarseillesMarseilles, IL, CCN 148649 Rural health clinic Contracted Managing Employee
Operational/Managerial Control		 Dec 1, 2022
Dec 1, 2022

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 9

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

Hospital & facility affiliations 7

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": "1127174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364169600000",
    "number": "1356336952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1614 E NORRIS DR",
            "city": "OTTAWA",
            "state": "IL",
            "postal_code": "613503681",
            "telephone_number": "815-433-1010",
            "fax_number": "815-433-0067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1614 E NORRIS DR",
            "city": "OTTAWA",
            "state": "IL",
            "postal_code": "613503681",
            "telephone_number": "815-433-1010",
            "fax_number": "815-433-0067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUEORGUIEV",
        "first_name": "GUEORGUI",
        "middle_name": "S",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-20",
        "last_updated": "2013-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036105269",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "127259",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ottawa, IL

Sources for this page

Verify at the official NPI Registry.