Active NPI
Trina Scott
- Family Medicine Physician
- Peoria, IL
National Provider Identifier
1508958307
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 036-106359
- Practice address
- 815 Main St
Peoria, IL 61602-1076 - Phone
- (309) 672-4977
- NPI assigned
- Sep 29, 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 | 036-106359 | IL | Primary |
Addresses
Primary practice location
815 Main St
Peoria, IL 61602-1076
Mailing address
5100 Reliable Pkwy
Chicago, IL 60686-0001
Phone (309) 672-4809
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036106359 | Medicaid | IL |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-106359 | IL | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1294876800000",
"number": "1508958307",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5100 RELIABLE PKWY",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606860001",
"telephone_number": "309-672-4809"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "815 MAIN ST",
"city": "PEORIA",
"state": "IL",
"postal_code": "616021076",
"telephone_number": "309-672-4977"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SCOTT",
"first_name": "TRINA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-29",
"last_updated": "2011-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "036-106359",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036106359",
"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 Jan 13, 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.