NPIMap

Organization Active NPI

Premier Medical Group, LLC

  • Podiatrist
  • Pontiac, IL
National Provider Identifier
1497054720
Registry record updated Mar 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
016-005106 Issued in IL
Legal business name
PREMIER MEDICAL GROUP, LLC
Practice address
1512 W Reynolds St Ste a
Pontiac, IL 61764-9788
Phone
(815) 842-6551
Fax
(815) 844-4106
NPI assigned
Mar 25, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 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
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X 016-005106 IL Primary

Addresses

Primary practice location

1512 W Reynolds St Ste a
Pontiac, IL 61764-9788

Mailing address

1512-A Reynolds
Pontiac, IL 61764-1745
Phone (815) 842-6551

Other names 1

  • Scott O'Connor, DPM 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.

Locations

1512 W Reynolds St
Ste A
Pontiac, IL 61764
Phone (815) 842-6551

NPI Registry JSON

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

{
    "created_epoch": "1301011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301011200000",
    "number": "1497054720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1512-A REYNOLDS",
            "city": "PONTIAC",
            "state": "IL",
            "postal_code": "617641745",
            "telephone_number": "815-842-6551",
            "fax_number": "815-844-4106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1512 W REYNOLDS ST STE A",
            "city": "PONTIAC",
            "state": "IL",
            "postal_code": "617649788",
            "telephone_number": "815-842-6551",
            "fax_number": "815-844-4106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-25",
        "last_updated": "2011-03-25",
        "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": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "IL",
            "license": "016-005106",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Scott O'Connor, DPM",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pontiac, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 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.