Active NPI
Katie Michelle Stapleton, DO
- Pediatrics Physician
- Peoria, IL
National Provider Identifier
1578186839
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 125.076594
- Practice address
- Osf St Francis Medical Center 530 NE Glen Oak Avenue
Peoria, IL 61637-0001 - Phone
- (309) 655-2274
- NPI assigned
- May 21, 2020
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 125.076594 | IL | Primary |
Addresses
Primary practice location
Osf St Francis Medical Center 530 NE Glen Oak Avenue
Peoria, IL 61637-0001
Mailing address
3306 Brittany Cir
Bloomington, IL 61704-8365
Phone (309) 242-1112
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201010000005 | IL | Order and Referring Only - Pediatric Medicine | 6901226083 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125.076594 | IL | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1590019200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1590019200000",
"number": "1578186839",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3306 BRITTANY CIR",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617048365",
"telephone_number": "309-242-1112"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "OSF ST FRANCIS MEDICAL CENTER 530 NE GLEN OAK AVENUE",
"city": "PEORIA",
"state": "IL",
"postal_code": "616370001",
"telephone_number": "309-655-2274"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STAPLETON",
"first_name": "KATIE",
"middle_name": "MICHELLE",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-05-21",
"last_updated": "2020-05-21",
"certification_date": "2020-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IL",
"license": "125.076594",
"primary": true
}
],
"identifiers": [],
"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 May 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.