Edward W Pegg MD, LLC

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

036071077 Issued in IL

Legal business name

EDWARD W PEGG MD, LLC

Practice address

1505 Eastland Dr Ste 2400
Bloomington, IL 61701-7911

Phone

(309) 661-7344

Fax

(309) 661-7343

NPI assigned

Jun 18, 2007

Last updated

May 29, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Edward W Pegg III, MD

Title

Owner

Phone

(309) 661-7344

Specialties & licenses 1

Addresses

Other identifiers 2

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/12409/brand/1/csg/1/fhir/r4

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

{
    "created_epoch": "1182124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212019200000",
    "number": "1568667772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1505 EASTLAND DR STE 2400",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617017911",
            "telephone_number": "309-661-7344",
            "fax_number": "309-661-7343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 EASTLAND DR STE 2400",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617017911",
            "telephone_number": "309-661-7344",
            "fax_number": "309-661-7343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWARD W PEGG MD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-18",
        "last_updated": "2008-05-29",
        "status": "A",
        "authorized_official_last_name": "PEGG",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "309-661-7344",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "IL",
            "license": "036071077",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "05732102",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1043392160",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eastland Psychological Services, LTD.
• Taylor Jolene Eastwood
• Mehrnoosh Ebadi
• Patti Ecker, MA, LCPC
• Kelsey Eddington, PA-C
• Ajah I Edwards
• Erin Lynne Edwards
• David Efaw, MD, DDS
• David Mark Ehlers
• Anabelle M Ehman

• Neurology Physician in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Neurology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 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.

Verify at the official NPI Registry.