NPIMap

Organization Active NPI

Pediatric Group, LLC

  • Pediatrics Physician
  • Centralia, IL
National Provider Identifier
1487290615
Registry record updated Oct 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEDIATRIC GROUP, LLC
Practice address
130 S Lincoln Blvd
Centralia, IL 62801-3654
Phone
(618) 993-0404
Fax
(618) 993-1717
NPI assigned
Nov 22, 2019
Last updated
Oct 23, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
PEDIATRIC GROUP, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 23, 2023

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

Authorized official

Name
Rhonda Lynn Fisher
Title
Office Manager
Phone
(618) 993-0404

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X Primary

Addresses

Primary practice location

130 S Lincoln Blvd
Centralia, IL 62801-3654

Mailing address

3412 Office Park Dr
Marion, IL 62959-6477
Phone (618) 993-0404

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Group LLC5 organizations share this tax ID, including this one
Part of
Pediatric Group LLC

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

130 S Lincoln Blvd
Centralia, IL 62801
Phone (618) 292-9999

NPI Registry JSON

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

{
    "created_epoch": "1574380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698019200000",
    "number": "1487290615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3412 OFFICE PARK DR",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629596477",
            "telephone_number": "618-993-0404",
            "fax_number": "618-993-1717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 S LINCOLN BLVD",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628013654",
            "telephone_number": "618-993-0404",
            "fax_number": "618-993-1717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEDIATRIC GROUP, LLC",
        "enumeration_date": "2019-11-22",
        "last_updated": "2023-10-23",
        "certification_date": "2023-09-29",
        "status": "A",
        "authorized_official_last_name": "FISHER",
        "authorized_official_first_name": "RHONDA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "618-993-0404"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Centralia, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.