Marc D Squillante, D.O.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

Practice address

530 NE Glen Oak Ave
Peoria, IL 61637-0001

Phone

(309) 655-2553

Fax

(309) 655-2602

NPI assigned

Jun 21, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Osf Healthcare System

  • Critical Access Hospital
  • Monmouth, IL
  • NPI 1548393184
  Medicare reassignment NPD
• Osf Multi-Specialty Group

  • Internal Medicine Physician
  • Peoria, IL
  • NPI 1922445527
  Medicare reassignment NPD
• Saint Francis Medical Center

  • Physical Medicine & Rehabilitation Physician
  • Peoria, IL
  • NPI 1023062312
  Medicare reassignment NPD
• Saint Francis Medical Center

  • Home Health Agency
  • Peoria, IL
  • NPI 1346281425
  NPD
• Saint Francis Medical Center

  • Emergency Medical Services (Emergency Medicine) Physician
  • Peoria, IL
  • NPI 1952351397
  NPD
• Central PA Pharmacy LLC.

  • Community/Retail Pharmacy
  • Patton, PA
  • NPI 1578541413
  NPD

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1477599272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616370001",
            "telephone_number": "309-655-2000",
            "fax_number": "309-655-7869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616370001",
            "telephone_number": "309-655-2553",
            "fax_number": "309-655-2602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SQUILLANTE",
        "first_name": "MARC",
        "middle_name": "D",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-21",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NO.",
            "identifier": "800810",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Renae Springer, APN
• Springfield Clinic LLP
• Springfield Clinic LLP
• Gretchen R. Sprouse, O.T.
• Christina Marie Spurgeon, MSN, NNP-BC
• Pavana Sreenivasan, M.D.
• Srinivas Jujjavarapu MD LLC
• Shreyas Srinivasan, DO
• Priyasha Srivastava, M.D.
• St. Francis Medical Center

• Emergency Medicine Physician in Peoria, IL
• Providers in Peoria, IL by specialty
• Emergency Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.