Individual provider Active NPI

Meera Gopu, MD

  • Plastic Surgery within the Head & Neck (Otolaryngology) Physician
  • Peoria, IL
National Provider Identifier
1609442912
Registry record updated Nov 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery within the Head & Neck (Otolaryngology) PhysicianTaxonomy code 207YX0007X
License
288601 Issued in MA
Practice address
8600 Illinois RT 91
Ste. 300
Peoria, IL 61615
Phone
(309) 691-6616
Fax
(309) 282-3848
NPI assigned
May 28, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery within the Head & Neck (Otolaryngology) Physician 207YX0007X 288601 MA Primary

Addresses

Primary practice location

8600 Illinois RT 91
Ste. 300
Peoria, IL 61615

Mailing address

8600 Illinois RT 91
Ste 300
Peoria, IL 61615

Other practice location 1

736 Cambridge St
Brighton, MA 02135-2907
Phone (617) 789-3000

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
I20230818001714 IL Practitioner - Otolaryngology 6305208513 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

8600 State Route 91
Suite 130
Peoria, IL 61615-7829
Phone (309) 683-5050

8800 State Route 91
Peoria, IL 61615-9473
Phone (309) 683-5000

Hospital & facility affiliations

  • Saint Francis Medical Center Hospital, Peoria, IL, CCN 140067
  • St Mary Medical Center Hospital, Galesburg, IL, CCN 140064

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
288601MAMDPlastic Surgery within the Head & Neck (Otolaryngology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Aug 4, 2023 Accepting new patients

Locations

1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195

8600 State Route 91
Ste 300
Peoria, IL 61615
Phone (309) 691-6616

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

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

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": "1622160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732492800000",
    "number": "1609442912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8600 ILLINOIS RT 91",
            "address_2": "STE 300",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "61615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8600 ILLINOIS RT 91",
            "address_2": "STE. 300",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "61615",
            "telephone_number": "309-691-6616",
            "fax_number": "309-282-3848"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "736 Cambridge St",
            "address_purpose": "LOCATION",
            "city": "Brighton",
            "state": "MA",
            "postal_code": "021352907",
            "country_code": "US",
            "telephone_number": "617-789-3000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOPU",
        "first_name": "MEERA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-28",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0007X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Plastic Surgery within the Head & Neck",
            "state": "MA",
            "license": "288601",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.