Active NPI
Pekin Prohealth Inc
- Oxygen Equipment & Supplies (DME)
- Pekin, IL
National Provider Identifier
1437101763
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oxygen Equipment & Supplies (DME)
- License
- 203000261
- Legal business name
- PEKIN PROHEALTH INC
- Practice address
- 1416 N 8TH St
Pekin, IL 61554-2103 - Phone
- (309) 347-4663
- Fax
- (309) 347-5127
- NPI assigned
- May 16, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Scott L Haynes
- Title
- Director
- Phone
- (309) 347-4663
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oxygen Equipment & Supplies (DME) | 332BX2000X | 203000261 | IL | Primary |
Addresses
Primary practice location
1416 N 8TH St
Pekin, IL 61554-2103
Mailing address
1416 N 8TH St
Pekin, IL 61554-2103
Phone (309) 347-4663
Other names 1
- PROCARE HOME HEALTH SERVICES
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031110000647 | IL | Part B Supplier - Clinic/Group Practice | 1951214576 |
Receives reassigned benefits from 155 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Chicago, IL; Hinsdale, IL; Pekin, IL; South Barrington, IL |
Other NPIs on the same Medicare enrollment 3
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147737600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1208649600000",
"number": "1437101763",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1416 N 8TH ST",
"city": "PEKIN",
"state": "IL",
"postal_code": "615542103",
"telephone_number": "309-347-4663",
"fax_number": "309-347-5127"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1416 N 8TH ST",
"city": "PEKIN",
"state": "IL",
"postal_code": "615542103",
"telephone_number": "309-347-4663",
"fax_number": "309-347-5127"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PEKIN PROHEALTH INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-16",
"last_updated": "2008-04-20",
"status": "A",
"authorized_official_last_name": "HAYNES",
"authorized_official_first_name": "SCOTT",
"authorized_official_middle_name": "L",
"authorized_official_title_or_position": "DIRECTOR",
"authorized_official_telephone_number": "309-347-4663",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "332BX2000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
"state": "IL",
"license": "203000261",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "PROCARE HOME HEALTH SERVICES",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Pekin, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.