NPIMap

Individual provider Active NPI

Amy M Matheis-Soliman, DO

  • Family Medicine Physician
  • Mendota, IL
National Provider Identifier
1376566539
Registry record updated May 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036-116774 Issued in IL
Practice address
1405 East 12TH Street
Suite 600
Mendota, IL 61342-9216
Phone
(815) 538-7200
Fax
(815) 539-1718
NPI assigned
Jul 26, 2006
Last updated
May 22, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2024

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 036-116774 IL Primary

Addresses

Primary practice location

1405 East 12TH Street
Suite 600
Mendota, IL 61342-9216

Mailing address

1401 East 12TH Street
Mendota, IL 61342-9216
Phone (815) 539-7461

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
I20060830000290 IL Practitioner - Family Practice 8325042500 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Midwestern University, Chicago College of Osteopathic Med, 2004
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)

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

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-116774ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mendota Community Hospital CurrentSince Sep 1, 2007 Accepting new patients
Ottawa Regional Hospital & Healthcare Center Current Accepting new patients
Mendota Community Hospital Family Medicine Current Accepting new patients
Mendota Community Hospital CurrentSince Sep 1, 2007 Accepting new patients
Ottawa Regional Hospital & Healthcare Center Family Medicine CurrentSince Mar 5, 2024 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Multi-Specialty Group CurrentSince May 22, 2024 Accepting new patients

Locations

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

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

1405 E 12th St
Mendota, IL 61342
Phone (815) 538-2031

1405 E 12th St
Ste 600
Mendota, IL 61342
Phone (815) 538-7200

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

Organizations & group practices 7

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 6

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": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716336000000",
    "number": "1376566539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 EAST 12TH STREET",
            "city": "MENDOTA",
            "state": "IL",
            "postal_code": "613429216",
            "telephone_number": "815-539-7461",
            "fax_number": "815-538-5516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 EAST 12TH STREET",
            "address_2": "SUITE 600",
            "city": "MENDOTA",
            "state": "IL",
            "postal_code": "613429216",
            "telephone_number": "815-538-7200",
            "fax_number": "815-539-1718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHEIS-SOLIMAN",
        "first_name": "AMY",
        "middle_name": "M",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-26",
        "last_updated": "2024-05-22",
        "certification_date": "2024-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-116774",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mendota, IL

Sources for this page

Verify at the official NPI Registry.