NPIMap

Individual provider Active NPI

Brad A. Stoecker, MD

  • Family Medicine Physician
  • Roanoke, IL
National Provider Identifier
1508887860
Registry record updated Jul 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036-116395 Issued in IL
Practice address
401 N Main St
Roanoke, IL 61561-7516
Phone
(309) 923-2661
Fax
(309) 923-7628
NPI assigned
Jul 22, 2006
Last updated
Jul 25, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036-116395 IL Primary

Addresses

Primary practice location

401 N Main St
Roanoke, IL 61561-7516

Mailing address

401 N Main St
Roanoke, IL 61561-7516
Phone (309) 923-2661

Other identifiers 7

IdentifierTypeStateIssuer
P00406153OtherRR MEDICARE IND. #
809840OtherILMEDICARE GROUP #
036116395MedicaidIL
833230OtherGROUP # FOR PONTIAC
CA4079OtherRR MEDICARE GROUP #
P00601872OtherILRR MEDICARE IND PTAN (PONTIAC)
CA2182OtherILRR MEDICARE GROUP PTAN (PONTIAC)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060830000470 IL Practitioner - Family Practice 1153325352 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians
Saint James HospitalGroup PAC ID 0648187252, 74 clinicians

Practice addresses (Care Compare)

401 N Main St
Roanoke, IL 61561-7585
Phone (309) 923-2661

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-116395ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saint James Hospital CurrentSince May 15, 2023 Accepting new patients
Saint James Hospital Family Medicine CurrentSince May 15, 2023 Accepting new patients
Osf Healthcare System CurrentSince Sep 20, 2010 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Healthcare System CurrentSince Sep 20, 2010 Accepting new patients
Saint James Hospital Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Jan 1, 2016 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

106 S 1st St
Fairbury, IL 61739
Phone (815) 635-3177

1000 W Harlem Ave
Monmouth, IL 61462
Phone (309) 734-1414

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

2500 W Reynolds St
Pontiac, IL 61764
Phone (815) 842-2828

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Osf Healthcare - Medical Group - RoanokeRoanoke, IL, CCN 148658 Rural health clinic Contracted Managing Employee
Operational/Managerial Control		 Feb 1, 2023
Feb 1, 2023

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Saint James Hospital

    dba OSF Healthcare - Medical Group - Roanoke

    • Rural Health Clinic/Center
    • Roanoke, IL
    • NPI 1164138848

    Contracted Managing Employee, Operational/Managerial Control

    CMS ownership

Organizations & group practices 8

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.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216944000000",
    "number": "1508887860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 N MAIN ST",
            "city": "ROANOKE",
            "state": "IL",
            "postal_code": "615617516",
            "telephone_number": "309-923-2661",
            "fax_number": "309-923-7628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 N MAIN ST",
            "city": "ROANOKE",
            "state": "IL",
            "postal_code": "615617516",
            "telephone_number": "309-923-2661",
            "fax_number": "309-923-7628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOECKER",
        "first_name": "BRAD",
        "middle_name": "A.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-22",
        "last_updated": "2008-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-116395",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE IND. #",
            "identifier": "P00406153",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP #",
            "identifier": "809840",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036116395",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP # FOR PONTIAC",
            "identifier": "833230",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE GROUP #",
            "identifier": "CA4079",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE IND PTAN (PONTIAC)",
            "identifier": "P00601872",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE GROUP PTAN (PONTIAC)",
            "identifier": "CA2182",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, IL

Sources for this page

Verify at the official NPI Registry.