NPIMap

Organization Active NPI

Premier Medical Group, LLC

  • Plastic Surgery Physician
  • Bloomington, IL
National Provider Identifier
1487943593
Registry record updated Mar 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
36-084126 Issued in IL
Legal business name
PREMIER MEDICAL GROUP, LLC
Practice address
1505 Eastland Dr
Suite 350
Bloomington, IL 61701-3534
Phone
(309) 663-1222
Fax
(309) 663-0580
NPI assigned
Mar 30, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2011

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

Authorized official

Name
Mr. John Hesse
Title
Executive Administrator
Phone
(309) 662-6200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208200000X 36-084126 IL Primary

Addresses

Primary practice location

1505 Eastland Dr
Suite 350
Bloomington, IL 61701-3534

Mailing address

1505 Eastland Dr
Suite 350
Bloomington, IL 61701-3534
Phone (309) 663-1222

Other names 1

  • Center for Cosmetic and Laser Surgery, LLC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Premier Medical Group LLC12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

NPI Registry JSON

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

{
    "created_epoch": "1301443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301443200000",
    "number": "1487943593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1505 EASTLAND DR",
            "address_2": "SUITE 350",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617013534",
            "telephone_number": "309-663-1222",
            "fax_number": "309-663-0580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 EASTLAND DR",
            "address_2": "SUITE 350",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617013534",
            "telephone_number": "309-663-1222",
            "fax_number": "309-663-0580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-30",
        "last_updated": "2011-03-30",
        "status": "A",
        "authorized_official_last_name": "HESSE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "EXECUTIVE ADMINISTRATOR",
        "authorized_official_telephone_number": "309-662-6200",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": "IL",
            "license": "36-084126",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Center for Cosmetic and Laser Surgery, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bloomington, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2011; 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.