Individual provider Active NPI

Marc Douglas Knepp, M.D.

  • Pediatric Cardiology Physician
  • Peoria, IL
National Provider Identifier
1568686277
Registry record updated Nov 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
License
036-129846 Issued in IL
Practice address
420 NE Glen Oak Ave
Suite 301
Peoria, IL 61603-3105
Phone
(309) 655-3456
Fax
(309) 655-3410
NPI assigned
Apr 12, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 4301083662 MI
Internal Medicine Physician 207R00000X 4301083662 MI
Pediatrics Physician 208000000X 4301083662 MI
Pediatric Cardiology Physician 2080P0202X 036-129846 IL Primary

Addresses

Primary practice location

420 NE Glen Oak Ave
Suite 301
Peoria, IL 61603-3105

Mailing address

420 NE Glen Oak Ave
Suite 301
Peoria, IL 61603-3105
Phone (309) 655-3453

Other practice location 1

1000 Health Center Dr
Mattoon, IL 61938-4644
Phone (217) 238-4960

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120828000835 IL Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Pediatric Medicine 0446421960 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Pediatric Medicine
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

Practice addresses (Care Compare)

1 Illini Dr
Peoria, IL 61605-2576
Phone (309) 671-8484

420 Neglen Oak Ave
Suite 301
Peoria, IL 61603
Phone (309) 655-3453

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-129846ILMDPediatric Cardiology Physician
4301083662MIMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Sarah Bush Lincoln Health Center Current Accepting new patients
Board of Trustees of the University of Illinois Internal Medicine CurrentSince Apr 1, 2020 Accepting new patients
Sarah Bush Lincoln Health Center CurrentSince Aug 13, 2022 Accepting new patients
Hoopeston Community Memorial Hospital Current Accepting new patients
Osf Multi-Specialty Group Internal Medicine CurrentSince Jan 1, 2016 Accepting new patients
The Board of Trustees of the University of Illinois CurrentSince Apr 1, 2020 Accepting new patients
Genesis Health System CurrentSince Sep 1, 2018 Accepting new patients
Hoopeston Community Memorial Hospital CurrentSince Jun 8, 2012 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
The Board of Trustees of the University of Illinois Current Accepting new patients
Carle Health Care Incorporated Internal Medicine CurrentSince Nov 26, 2012 Accepting new patients
Hoopeston Community Memorial Hospital Internal Medicine CurrentSince Jun 8, 2012 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Cardinal Medical Group, LTD. Past Accepting new patients

Locations

7694 Solutions Ctr
Chicago, IL 60677

215 E 1st St
Ste 105
Dixon, IL 61021
Phone (815) 285-5603

837 E Orange St
Hoopeston, IL 60942
Phone (217) 283-5530

701 E Orange St
Hoopeston, IL 60942
Phone (217) 283-5531

101 Professional Plz
Mattoon, IL 61938
Phone (217) 238-3730

1000 Health Center Dr
Ste H
Mattoon, IL 61938

1000 Health Center Dr
Mattoon, IL 61938
Phone (217) 258-2389

1000 Medical Center Dr
Monticello, IL 61856
Phone (217) 762-1540

420 NE Glen Oak Ave
Ste 304
Peoria, IL 61603
Phone (877) 464-6640

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

1 Illini Dr
Peoria, IL 61605
Phone (309) 671-3000

420 NE Glen Oak Ave
Ste 301
Peoria, IL 61603
Phone (309) 655-7668

420 NE Glen Oak Ave
Ste 30
Peoria, IL 61603

444 Roxbury Rd
Rockford, IL 61107
Phone (815) 395-9196

444 Roxbury Rd
#12471
Rockford, IL 61107

801 Illini Dr
Silvis, IL 61282
Phone (309) 281-4000

2524 Farragut Dr
Springfield, IL 62704
Phone (217) 726-9020

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

1405 W Park St
Urbana, IL 61801
Phone (217) 337-3240

Interoperability endpoints

  • Direct secure messaging: mknepp34223@cghmc.direct-ci.com

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 1

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": "1176336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668124800000",
    "number": "1568686277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 NE GLEN OAK AVE",
            "address_2": "SUITE 301",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616033105",
            "telephone_number": "309-655-3453",
            "fax_number": "309-655-3410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 NE GLEN OAK AVE",
            "address_2": "SUITE 301",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616033105",
            "telephone_number": "309-655-3456",
            "fax_number": "309-655-3410"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 Health Center Dr",
            "address_purpose": "LOCATION",
            "city": "Mattoon",
            "state": "IL",
            "postal_code": "619384644",
            "country_code": "US",
            "telephone_number": "217-238-4960",
            "fax_number": "217-238-4951",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KNEPP",
        "first_name": "MARC",
        "middle_name": "DOUGLAS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-12",
        "last_updated": "2022-11-11",
        "certification_date": "2022-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": "4301083662",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301083662",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301083662",
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "IL",
            "license": "036-129846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.