Active NPI
Aleetra Roberts, MD
- Family Medicine Physician
- Peoria, IL
National Provider Identifier
1588356190
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 036179551
- Practice address
- 815 Main St Ste C
Peoria, IL 61602-1080 - Phone
- (309) 672-4986
- NPI assigned
- May 23, 2023
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Family Medicine Physician | 207Q00000X | 036179551 | IL | Primary |
Addresses
Primary practice location
815 Main St Ste C
Peoria, IL 61602-1080
Mailing address
815 Main St Ste C
Peoria, IL 61602-1080
Phone (309) 672-4986
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 |
|---|---|---|---|---|
| I20260528000479 | IL | Practitioner - Family Practice | 4486137387 |
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2023
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
221 NE Glen Oak Ave
Peoria, IL 61636-0001
511 Chloe Rd
Pikeville, KY 41501-1585
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Interoperability endpoints
- aleetra.roberts.1@21094.direct.athenahealth.com
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Peoria, IL
- NPI 1164474755
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1684800000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1787270400000",
"number": "1588356190",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "815 MAIN ST STE C",
"city": "PEORIA",
"state": "IL",
"postal_code": "616021080",
"telephone_number": "309-672-4986"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "815 MAIN ST STE C",
"city": "PEORIA",
"state": "IL",
"postal_code": "616021080",
"telephone_number": "309-672-4986"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "ALEETRA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-05-23",
"last_updated": "2026-08-21",
"certification_date": "2026-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "036179551",
"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 Aug 21, 2026; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.