Benito Camacho, MD – Internal Medicine Physician

Key facts

NPI: 1477634285
Entity type: Individual (NPI type 1)
Primary specialty: Internal Medicine Physician 207R00000X
License: 036-047383 (IL)
Practice address: 1800 N Knoxville Ave Ste a
Peoria, IL 61603-3005
Phone: (309) 680-7600
Fax: (309) 495-8614
NPI assigned: Oct 18, 2006
Sex: Male
Sole proprietor: No

Organizations & group practices 3

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.

The Board of Trustees of the University of Illinois Anatomic Pathology Physician · Chicago, IL · NPI 1386863819

Medicare reassignment NPD IL
Board of Trustees of the University of Illinois Pediatrics Physician · Peoria, IL · NPI 1467425322

NPD INTERNAL MEDICINE
The Board of Trustees of the University of Illinois Occupational Medicine Physician · Chicago, IL · NPI 1043727571

NPD

Medicare participation

Medicare fee-for-service enrollment: Enrolled in IL
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20080107000140	IL	Practitioner - Internal Medicine	1557441326	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Doctor of Medicine

State licenses

License	State	Type	Specialty
036-047383	IL	MD	Internal Medicine Physician

Practice roles

Organization	Specialty	Status	New patients
The Board of Trustees of the University of Illinois		Current	Accepting new patients
Board of Trustees of the University of Illinois	Internal Medicine	Current since Nov 15, 2007	Accepting new patients
The Board of Trustees of the University of Illinois		Current since Nov 15, 2007	Accepting new patients

Locations

7694 Solutions Ctr
Chicago, IL 60677

200 E Pennsylvania Ave
Peoria, IL 61603
Phone (309) 624-4000

530 NE Glen Oak Ave
Peoria, IL 61637
Phone (309) 655-2553

1 Illini Dr
Peoria, IL 61605
Phone (309) 671-3000

320 E Armstrong Ave
Peoria, IL 61603
Phone (309) 624-9587

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Internal Medicine Physician	207R00000X	036-047383	IL	Yes

Addresses

Primary practice location

1800 N Knoxville Ave Ste a
Peoria, IL 61603-3005

Mailing address

2214 N University St
Peoria, IL 61604-3221
Phone (309) 680-7669

Other practice location 1

200 E Pennsylvania Ave
Peoria, IL 61603-3089
Phone (309) 655-7990

Other identifiers

Identifier	Type	State	Issuer
036047383	Medicaid	IL

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 30, 2020.

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609286400000",
    "number": "1477634285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2214 N UNIVERSITY ST",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616043221",
            "telephone_number": "309-680-7669",
            "fax_number": "309-681-8443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 N KNOXVILLE AVE STE A",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616033005",
            "telephone_number": "309-680-7600",
            "fax_number": "309-495-8614"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 E Pennsylvania Ave",
            "address_purpose": "LOCATION",
            "city": "Peoria",
            "state": "IL",
            "postal_code": "616033089",
            "country_code": "US",
            "telephone_number": "309-655-7990",
            "fax_number": "309-655-7953",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CAMACHO",
        "first_name": "BENITO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-18",
        "last_updated": "2020-12-30",
        "certification_date": "2020-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036-047383",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036047383",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

All providers in Peoria, IL · Internal Medicine Physician in Illinois

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 30, 2020. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.