Active NPI
Ingrid C. Antonsen, M.D.
- Family Medicine Physician
- Champaign, IL
National Provider Identifier
1508870601
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 036-077650
- Practice address
- 1801 Windsor Rd
Champaign, IL 61822-6217 - Phone
- (217) 366-6104
- NPI assigned
- Jul 27, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036-077650 | IL | Primary |
Addresses
Primary practice location
1801 Windsor Rd
Champaign, IL 61822-6217
Mailing address
1801 Windsor Rd
Champaign, IL 61822-6217
Phone (217) 366-6104
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036077650-2 | Medicaid | IL | |
| 279500 | Other | IL | MEDICARE GROUP |
| 080065701 | Other | IL | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1222300800000",
"number": "1508870601",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1801 WINDSOR RD",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618226217",
"telephone_number": "217-366-6104"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1801 WINDSOR RD",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618226217",
"telephone_number": "217-366-6104"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANTONSEN",
"first_name": "INGRID",
"middle_name": "C.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-27",
"last_updated": "2008-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "036-077650",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036077650-2",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP",
"identifier": "279500",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "080065701",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Champaign, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.