Individual provider Active NPI

John Michael Irish, MD

  • Vascular & Interventional Radiology Physician
  • Peoria, IL
National Provider Identifier
1619318235
Registry record updated Oct 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
036-147061 Issued in IL
Practice address
530 NE Glen Oak Ave
Peoria, IL 61637-1000
Phone
(309) 655-2000
NPI assigned
Jul 11, 2013
Last updated
Oct 23, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 2013022996 MO
Vascular & Interventional Radiology Physician 2085R0204X 036-147061 IL Primary

Addresses

Primary practice location

530 NE Glen Oak Ave
Peoria, IL 61637-1000

Mailing address

111 Oakwood Rd
East Peoria, IL 61611-1853
Phone (309) 740-4272

Other practice location 1

701 N 1st St
Springfield, IL 62781-1000
Phone (217) 788-3000

Other practice location 2

7900 Lees Summit Rd
Kansas City, MO 64139-1236
Phone (816) 404-0690

Other practice location 3

2301 Holmes St
Kansas City, MO 64108-2640
Phone (816) 404-0690

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
I20190806004139 IL Practitioner - Interventional RadiologyPractitioner - Diagnostic Radiology 9133474034 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Interventional Radiology
Education
Rush Medical College of Rush University, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Central Illinois Radiological Associates LTDGroup PAC ID 9436061827, 205 clinicians
Cira Michigan PCGroup PAC ID 7113355264, 89 clinicians
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

111 Oakwood Rd
East Peoria, IL 61611-1853
Phone (309) 740-4272

5213 Eagle RDG
Springfield, IL 62711-7809
Phone (309) 740-4272

530 Park Ave E
Princeton, IL 61356-3903

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

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal1-10
Leg revascularization (restoring blood flow)13

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2013022996MOMDDiagnostic Radiology Physician
036-147061ILMDVascular & Interventional Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Illinois Radiological Associates, LTD. Diagnostic Radiology CurrentSince Jul 1, 2022 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Crawford Hospital District Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Jul 5, 2022 Accepting new patients
Cira Michigan PC Diagnostic Radiology CurrentSince Jul 1, 2022 Accepting new patients
Memorial Medical Center Past Accepting new patients
Clinical Radiologists, S.C. Diagnostic Radiology PastSince Oct 20, 2019 Accepting new patients
Clinical Radiologists, S.C. Diagnostic Radiology PastSince Oct 20, 2019 Accepting new patients

Locations

5200 Reliable Pkwy
Chicago, IL 60686
Phone (309) 671-8748

111 Oakwood Rd
Peoria, IL 61611
Phone (586) 412-4144

530 NE Glen Oak Ave
Peoria, IL 61637
Phone (309) 655-2553

530neglen Oak Ave
Peoria, IL 61636
Phone (309) 685-1054

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

1000 N Allen St
Robinson, IL 62454
Phone (618) 544-3131

Organizations & group practices 8

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.

Hospital & facility affiliations 4

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": "1373500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698019200000",
    "number": "1619318235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 OAKWOOD RD",
            "city": "EAST PEORIA",
            "state": "IL",
            "postal_code": "616111853",
            "telephone_number": "309-740-4272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616371000",
            "telephone_number": "309-655-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 N 1st St",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "IL",
            "postal_code": "627811000",
            "country_code": "US",
            "telephone_number": "217-788-3000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7900 Lees Summit Rd",
            "address_purpose": "LOCATION",
            "city": "Kansas City",
            "state": "MO",
            "postal_code": "641391236",
            "country_code": "US",
            "telephone_number": "816-404-0690",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2301 Holmes St",
            "address_purpose": "LOCATION",
            "city": "Kansas City",
            "state": "MO",
            "postal_code": "641082640",
            "country_code": "US",
            "telephone_number": "816-404-0690",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IRISH",
        "first_name": "JOHN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-11",
        "last_updated": "2023-10-23",
        "certification_date": "2023-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MO",
            "license": "2013022996",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "IL",
            "license": "036-147061",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.