Individual provider Active NPI

Javier Hernandez Jr., DO

  • Pediatrics Physician
  • Peoria, IL
National Provider Identifier
1508516139
Registry record updated Jul 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
5101029040 Issued in MI
Practice address
530 NE Glen Oak Ave
Peoria, IL 61637-0001
Phone
(309) 655-2000
NPI assigned
Mar 26, 2022
Last updated
Jul 7, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 5101029040 MI Primary

Addresses

Primary practice location

530 NE Glen Oak Ave
Peoria, IL 61637-0001

Mailing address

1540 E Medical Center Dr
Ann Arbor, MI 48109-0100
Phone (734) 615-7845

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240930000148 IL Practitioner - Pediatric MedicinePractitioner - Internal Medicine 3072044288 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric MedicineAlso: Internal Medicine
Education
Marian University College of Osteopathic Medicine, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Heartland Community Health ClinicGroup PAC ID 7416850318, shared by 4 NPIs, 50 clinicians

Practice addresses (Care Compare)

1701 W Garden St
Peoria, IL 61605-3531
Phone (309) 680-7600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Sep 17, 2024 Accepting new patients

Locations

124 SW Adams St
Peoria, IL 61602
Phone (309) 655-2850

5114 N Glen Park Place Rd
Peoria, IL 61614
Phone (309) 655-2431

5114 N Glen Park Place Rd
Ste 220
Peoria, IL 61614
Phone (309) 683-8100

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

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1648252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783382400000",
    "number": "1508516139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1540 E MEDICAL CENTER DR",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481090100",
            "telephone_number": "734-615-7845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616370001",
            "telephone_number": "309-655-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERNANDEZ",
        "first_name": "JAVIER",
        "name_suffix": "Jr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-26",
        "last_updated": "2026-07-07",
        "certification_date": "2026-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "5101029040",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.