Active NPI
Michael D Tarantino, MD
- Pediatric Hematology & Oncology Physician
- Peoria, IL
National Provider Identifier
1396731063
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Hematology & Oncology Physician
- License
- 036-101239
- Practice address
- 427 W Northmoor Rd
Peoria, IL 61614-3542 - Phone
- (309) 692-5337
- Fax
- (309) 693-3913
- NPI assigned
- Sep 27, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Hematology & Oncology Physician | 2080P0207X | 29978 | KY | |
| Pediatric Hematology & Oncology Physician | 2080P0207X | 036-101239 | IL | Primary |
Addresses
Primary practice location
427 W Northmoor Rd
Peoria, IL 61614-3542
Mailing address
427 W Northmoor Rd
Peoria, IL 61614-3542
Phone (309) 692-5337
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00096725 | Other | RAILROAD MEDICARE | |
| 64299787 | Other | KY | KENTUCKY MEDICAID |
| 7225372 | Other | IL | BCBS OF 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
Care Compare profile
Medicare Care Compare- Specialty
- Hematology/Oncology
- Education
- University of Wisconsin School of Medicine, 1987
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
427 W Northmoor Rd
Peoria, IL 61614-3542
Phone (309) 692-5337
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-101239 | IL | MD | Pediatric Hematology & Oncology Physician |
| 29978 | KY | MD | Pediatric Hematology & Oncology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Bleeding and Clotting Disorders Institute | Past | Accepting new patients | |
| Gibson Community Hospital Association | Past | Accepting new patients |
Interoperability endpoints
- michael.tarantino@4214.securemail.prognocis.com
Organizations & group practices 4
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.
-
- Pediatric Hematology & Oncology Physician
- Peoria, IL
- NPI 1740430784
-
- Clinic/Center
- Peoria, IL
- NPI 1134424633
-
- Specialty Pharmacy
- Peoria, IL
- NPI 1639508567
-
- Critical Access Hospital
- Gibson City, IL
- NPI 1114935681
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Peoria, IL
- NPI 1164474755
-
- General Acute Care Hospital
- Peru, IL
- NPI 1588713440
-
- General Acute Care Hospital
- Peoria, IL
- NPI 1033116876
-
- Rehabilitation Hospital Unit
- Peoria, IL
- NPI 1134826894
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127779200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1627603200000",
"number": "1396731063",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "427 W NORTHMOOR RD",
"city": "PEORIA",
"state": "IL",
"postal_code": "616143542",
"telephone_number": "309-692-5337",
"fax_number": "309-693-3913"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "427 W NORTHMOOR RD",
"city": "PEORIA",
"state": "IL",
"postal_code": "616143542",
"telephone_number": "309-692-5337",
"fax_number": "309-693-3913"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TARANTINO",
"first_name": "MICHAEL",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-09-27",
"last_updated": "2021-07-30",
"certification_date": "2021-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0207X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Hematology-Oncology",
"state": "KY",
"license": "29978",
"primary": false
},
{
"code": "2080P0207X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Hematology-Oncology",
"state": "IL",
"license": "036-101239",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00096725",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KENTUCKY MEDICAID",
"identifier": "64299787",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF IL",
"identifier": "7225372",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}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 Jul 30, 2021; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.