Active NPI
Scott Carlson
- Pediatrics Physician
- Washington, IL
National Provider Identifier
1386726255
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 036-076809
- Practice address
- 10 Saint Clare CT
Washington, IL 61571-9239 - Phone
- (309) 886-4003
- Fax
- (309) 886-4116
- NPI assigned
- Oct 20, 2006
- Last updated
- Apr 12, 2010
- Sex
- Male
- 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 | 036-076809 | IL | Primary |
Addresses
Primary practice location
10 Saint Clare CT
Washington, IL 61571-9239
Mailing address
10 Saint Clare CT
Washington, IL 61571-9239
Phone (309) 886-4003
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036076809 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050725000328 | IL | Practitioner - Pediatric Medicine | 7214964949 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-076809 | IL | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161302400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1271030400000",
"number": "1386726255",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 SAINT CLARE CT",
"city": "WASHINGTON",
"state": "IL",
"postal_code": "615719239",
"telephone_number": "309-886-4003",
"fax_number": "309-886-4116"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 SAINT CLARE CT",
"city": "WASHINGTON",
"state": "IL",
"postal_code": "615719239",
"telephone_number": "309-886-4003",
"fax_number": "309-886-4116"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLSON",
"first_name": "SCOTT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-20",
"last_updated": "2010-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IL",
"license": "036-076809",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036076809",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Washington, IL
- Dennis C Burton, DDS
- Kara Bushong, PT
- Lisa House/Apartment Byard
- Jon Byler
- Stephanie Calderas, RN
- Chelse Carr, LCPC
- Kelsey James Carreras-Simons, DDS
- Central Columbia Grade SCH 51
- Central Illinois Senior Care, Inc. (Home Helpers Home Care of East Peoria)
- Chapters Washington Opco LLC (Chapters Living of Washington)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 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.