Active NPI
Hrachya Nersesyan, M.D., PH.D.
- Neurology Physician
- Peoria, IL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 036121370
- Practice address
- 200 E Pennsylvania Ave
Peoria, IL 61603-3089 - Phone
- (309) 624-4000
- Fax
- (309) 624-4010
- NPI assigned
- Jun 1, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 036121370 | IL | Primary |
Addresses
Primary practice location
200 E Pennsylvania Ave
Peoria, IL 61603-3089
Mailing address
200 E Pennsylvania Ave
Peoria, IL 61603-3089
Phone (309) 624-4000
Other practice location 1
100 NE Randolph Ave
Peoria, IL 61606-1919
Phone (309) 624-8500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 809840 | Other | IL | MEDICARE GROUP PTAN |
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Neurology
- Education
- Other, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
200 E Pennsylvania Ave
Suite 101
Peoria, IL 61603-3084
Phone (309) 655-7888
8600 State Route 91
Suite 130
Peoria, IL 61615-7829
Phone (309) 683-5050
Hospital & facility affiliations
- Saint Francis Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036121370 | IL | MD | Neurology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Central PA Pharmacy LLC. | Current | Accepting new patients | |
| Osf Multi-Specialty Group | Current | Accepting new patients | |
| Gibson Community Hospital Association | Past | Accepting new patients |
Locations
200 E Pennsylvania Ave
Peoria, IL 61603
Phone (309) 624-4000
8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050
1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195
100 NE Randolph Ave
Peoria, IL 61606
Phone (309) 624-8500
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.
-
- Internal Medicine Physician
- Peoria, IL
- NPI 1922445527
-
- Community/Retail Pharmacy
- Patton, PA
- NPI 1578541413
-
- Critical Access Hospital
- Gibson City, IL
- NPI 1114935681
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180656000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1739145600000",
"number": "1497957468",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 E PENNSYLVANIA AVE",
"city": "PEORIA",
"state": "IL",
"postal_code": "616033089",
"telephone_number": "309-624-4000",
"fax_number": "309-624-4010"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 E PENNSYLVANIA AVE",
"city": "PEORIA",
"state": "IL",
"postal_code": "616033089",
"telephone_number": "309-624-4000",
"fax_number": "309-624-4010"
}
],
"practiceLocations": [
{
"address_1": "100 NE Randolph Ave",
"address_purpose": "LOCATION",
"city": "Peoria",
"state": "IL",
"postal_code": "616061919",
"country_code": "US",
"telephone_number": "309-624-8500",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NERSESYAN",
"first_name": "HRACHYA",
"credential": "M.D., PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-06-01",
"last_updated": "2025-02-10",
"certification_date": "2025-02-10",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "IL",
"license": "036121370",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP PTAN",
"identifier": "809840",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2025; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.