Active NPI
Christina Anderson, MD
- Student in an Organized Health Care Education/Training Program
- Peoria, IL
National Provider Identifier
1477073674
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 815 Main St Ste a
Peoria, IL 61602-1080 - Phone
- (309) 672-4977
- NPI assigned
- Jun 20, 2017
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
815 Main St Ste a
Peoria, IL 61602-1080
Mailing address
815 Main St Ste a
Peoria, IL 61602-1080
Phone (309) 672-4977
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 125.071192 | Other | LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1497916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1477073674",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "815 MAIN ST STE A",
"city": "PEORIA",
"state": "IL",
"postal_code": "616021080",
"telephone_number": "309-672-4977"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "815 MAIN ST STE A",
"city": "PEORIA",
"state": "IL",
"postal_code": "616021080",
"telephone_number": "309-672-4977"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "CHRISTINA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-06-20",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "125.071192",
"state": null
}
],
"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 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.