Active NPI
Clark B Rians, M.D.
- Sports Medicine (Internal Medicine) Physician
- Peoria, IL
National Provider Identifier
1568462687
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Internal Medicine) Physician
- License
- 36067263
- Practice address
- 303 N William Kumpf Blvd
Peoria, IL 61605-2507 - Phone
- (309) 676-5546
- Fax
- (309) 647-6504
- NPI assigned
- Jul 29, 2005
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Sports Medicine (Internal Medicine) Physician | 207RS0010X | 36067263 | IL | Primary |
Addresses
Primary practice location
303 N William Kumpf Blvd
Peoria, IL 61605-2507
Mailing address
303 N William Kumpf Blvd
Peoria, IL 61605-2507
Phone (309) 676-5546
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 36067263 | 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 |
|---|---|---|---|
| 36067263 | IL | MD | Sports Medicine (Internal Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1122595200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1259884800000",
"number": "1568462687",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "303 N WILLIAM KUMPF BLVD",
"city": "PEORIA",
"state": "IL",
"postal_code": "616052507",
"telephone_number": "309-676-5546",
"fax_number": "309-647-6504"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "303 N WILLIAM KUMPF BLVD",
"city": "PEORIA",
"state": "IL",
"postal_code": "616052507",
"telephone_number": "309-676-5546",
"fax_number": "309-647-6504"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIANS",
"first_name": "CLARK",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-29",
"last_updated": "2009-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "207RS0010X",
"taxonomy_group": "",
"desc": "Internal Medicine, Sports Medicine",
"state": "IL",
"license": "36067263",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "36067263",
"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 Dec 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.