NPIMap

Organization Active NPI

Board of Trustees of the University of Illinois

Doing business as Medical Service Plan at Peoria

  • Pediatrics Physician
  • Peoria, IL
National Provider Identifier
1467425322
Registry record updated Aug 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Doing business as
Medical Service Plan at Peoria
University of Illinois Medical Service Plan at Peoria
Practice address
1 Illini Dr
Peoria, IL 61605-2576
Phone
(309) 680-8649
Fax
(309) 671-8513
NPI assigned
Feb 10, 2006
Last updated
Aug 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2024

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

Authorized official

Name
Sherry Leonard
Title
Director of Fiscal Affairs
Phone
(309) 680-8649

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU
Infectious Disease Physician 207RI0200X IL
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

1 Illini Dr
Peoria, IL 61605-2576

Mailing address

1 Illini Dr
Peoria, IL 61605-2576
Phone (309) 671-8472

Other identifiers 2

IdentifierTypeStateIssuer
CH0107OtherILRAILROAD MEDICARE
07215036OtherILBCBS

Other names 2

  • Medical Service Plan at Peoria Doing business as
  • University of Illinois Medical Service Plan at Peoria Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031112000158 IL Part B Supplier - Clinic/Group Practice 3072422716 Receives reassigned benefits from 2,115 practitioners
44 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 44

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 44

National Provider Directory

National Provider Directory
Tax ID family
Uic Dept of Pathology122 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

7694 Solutions Ctr
Chicago, IL 60677

801 S Paulina St
Rm 330C
Chicago, IL 60612

222 NE Monroe St
Ste 904
Peoria, IL 61602
Phone (309) 224-5621

2900 N Knoxville Ave
Peoria, IL 61603
Phone (309) 308-2000

7042 N University St
Peoria, IL 61614

900 Main St
Ste 720
Peoria, IL 61602
Phone (309) 495-1640

Practitioners & affiliated clinicians

Practitioners 872

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 872

NPI Registry JSON

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

{
    "created_epoch": "1139529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722902400000",
    "number": "1467425322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 ILLINI DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616052576",
            "telephone_number": "309-671-8472",
            "fax_number": "309-671-8513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 ILLINI DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616052576",
            "telephone_number": "309-680-8649",
            "fax_number": "309-671-8513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-10",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "status": "A",
        "authorized_official_last_name": "LEONARD",
        "authorized_official_first_name": "SHERRY",
        "authorized_official_title_or_position": "DIRECTOR OF FISCAL AFFAIRS",
        "authorized_official_telephone_number": "309-680-8649"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CH0107",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "07215036",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Service Plan at Peoria",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "University of Illinois Medical Service Plan at Peoria",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Aug 6, 2024; 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.

Verify at the official NPI Registry.