John Carroll, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

036.064215 Issued in IL

Practice address

2727 W Heading Ave
West Peoria, IL 61604-4981

Phone

(309) 648-1087

NPI assigned

Sep 24, 2010

Sex

Male

Sole proprietor

Yes

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.

• DHHS, PHS, Naihs, Shiprock Hospital

  • General Acute Care Hospital
  • Shiprock, NM
  • NPI 1780639971
  Medicare reassignment NPD TX
• DHHS, PHS, Naihs, Shiprock Hospital

  • General Acute Care Hospital
  • Teecnospos, AZ
  • NPI 1477615789
  NPD

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 24, 2010.

{
    "created_epoch": "1285286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285286400000",
    "number": "1376852301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2727 W HEADING AVE",
            "city": "WEST PEORIA",
            "state": "IL",
            "postal_code": "616044981",
            "telephone_number": "309-648-1087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2727 W HEADING AVE",
            "city": "WEST PEORIA",
            "state": "IL",
            "postal_code": "616044981",
            "telephone_number": "309-648-1087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "JOHN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-09-24",
        "last_updated": "2010-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036.064215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Isaac Ibrahim Boktor
• Brin Diagnostics Inc.
• Kristen Leigh Brosch, LCPC
• Felicity Buedel, EMT
• Tonya Renae Camacho, LPCP
• Catholic Chariteis of the Diocese of Peorai
• Catholic Charities of the Diocese of Peoria
• Catholic Charities of the Diocese of Peoria
• Catholic Charities of the Diocese of Peoria
• Brianna M Coleman, PMHNP

• All providers in West Peoria, IL
• Emergency Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.