NPIMap

Organization Active NPI

Bromenn Healthcare Hospitals

  • Geriatric Medicine (Family Medicine) Physician
  • Normal, IL
National Provider Identifier
1396780854
Registry record updated Oct 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
Legal business name
BROMENN HEALTHCARE HOSPITALS
Practice address
1300 Franklin Ave
Suite 100
Normal, IL 61761-3588
Phone
(309) 268-3761
Fax
(309) 268-5620
NPI assigned
Jun 18, 2006
Last updated
Oct 6, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2008

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

Authorized official

Name
Mrs. Kathy O. Davis
Title
VP & Chief Information Officer
Phone
(309) 268-2410

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) Physician 207QG0300X NU Primary

Addresses

Primary practice location

1300 Franklin Ave
Suite 100
Normal, IL 61761-3588

Mailing address

1300 Franklin Ave
Suite 100
Normal, IL 61761-3588
Phone (309) 268-3761

Other identifiers 1

IdentifierTypeStateIssuer
5715390OtherILBLUE CROSS BLUE SHIELD

Other names 1

  • BroMenn Family Health Clinic Other name

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223251200000",
    "number": "1396780854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 FRANKLIN AVE",
            "address_2": "SUITE 100",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617613588",
            "telephone_number": "309-268-3761",
            "fax_number": "309-268-5620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 FRANKLIN AVE",
            "address_2": "SUITE 100",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617613588",
            "telephone_number": "309-268-3761",
            "fax_number": "309-268-5620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROMENN HEALTHCARE HOSPITALS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-18",
        "last_updated": "2008-10-06",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "KATHY",
        "authorized_official_middle_name": "O.",
        "authorized_official_title_or_position": "VP & CHIEF INFORMATION OFFICER",
        "authorized_official_telephone_number": "309-268-2410",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "5715390",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BroMenn Family Health Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Normal, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.