Active NPI
Peggy P Demikis, PHYSICIAN ASSISTANT
- Physician Assistant
- Harvey, IL
National Provider Identifier
1508962838
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 085000466
- Practice address
- One Ingalls Dr
W536
Harvey, IL 60426 - Phone
- (708) 915-6870
- Fax
- (708) 333-9105
- NPI assigned
- Sep 15, 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 085000466 | IL | Primary |
Addresses
Primary practice location
One Ingalls Dr
W536
Harvey, IL 60426
Mailing address
2650 Warrenville Rd
Suite 280
Downers Grove, IL 60515
Phone (630) 324-7911
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| L67625 | 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
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158278400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490918400000",
"number": "1508962838",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2650 WARRENVILLE RD",
"address_2": "SUITE 280",
"city": "DOWNERS GROVE",
"state": "IL",
"postal_code": "60515",
"telephone_number": "630-324-7911",
"fax_number": "630-324-7942"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "ONE INGALLS DR",
"address_2": "W536",
"city": "HARVEY",
"state": "IL",
"postal_code": "60426",
"telephone_number": "708-915-6870",
"fax_number": "708-333-9105"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEMIKIS",
"first_name": "PEGGY",
"middle_name": "P",
"credential": "PHYSICIAN ASSISTANT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-15",
"last_updated": "2017-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IL",
"license": "085000466",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "L67625",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Harvey, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.