NPIMap

Organization Active NPI

Methodist Medical Center of Illinois

  • School Nurse Practitioner
  • Peoria, IL
National Provider Identifier
1609685189
Registry record updated Dec 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
School Nurse PractitionerTaxonomy code 363LS0200X
Legal business name
METHODIST MEDICAL CENTER OF ILLINOIS
Practice address
6301 N University St
Peoria, IL 61614-3453
Phone
(309) 692-6650
NPI assigned
Dec 30, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2024

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

Authorized official

Name
Dr. Keith Knepp, M.D.
Title
President
Phone
(309) 671-2528

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
School Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LS0200X Primary

Addresses

Primary practice location

6301 N University St
Peoria, IL 61614-3453

Mailing address

221 NE Glen Oak Ave
Peoria, IL 61636-0001
Phone (309) 672-5522

Other names 1

  • Carle Health Peoria In School Health Richwoods Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D2321519Carle Health Methodist in School Health Richwoods6301 N University St, Peoria, IL 61614Certificate of waiverApr 3, 2027

National Provider Directory

National Provider Directory
Tax ID family
Methodist Medical Cente9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6301 N University St
Peoria, IL 61614
Phone (309) 692-6650

NPI Registry JSON

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

{
    "created_epoch": "1735516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735516800000",
    "number": "1609685189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616360001",
            "telephone_number": "309-672-5522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6301 N UNIVERSITY ST",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616143453",
            "telephone_number": "309-692-6650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METHODIST MEDICAL CENTER OF ILLINOIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-30",
        "last_updated": "2024-12-30",
        "certification_date": "2024-12-30",
        "status": "A",
        "authorized_official_last_name": "KNEPP",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "309-671-2528",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "363LS0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, School",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carle Health Peoria In School Health Richwoods",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Dec 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.

Verify at the official NPI Registry.