Active NPI
Wade A Siefert
- Pharmacist
- Peoria, IL
National Provider Identifier
1619625399
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051036934
- Practice address
- 10302 N Schopp LN
Peoria, IL 61615-1180 - Phone
- (309) 258-1574
- NPI assigned
- Mar 12, 2022
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051036934 | IL | Primary |
Addresses
Primary practice location
10302 N Schopp LN
Peoria, IL 61615-1180
Mailing address
10302 N Schopp LN
Peoria, IL 61615-1180
Phone (309) 258-1574
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | 3096792051 | Health Information Exchange (HIE) | Hy-Vee Inc |
| FHIR URL | 3096792051 | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051036934 | IL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1647043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1647043200000",
"number": "1619625399",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10302 N SCHOPP LN",
"city": "PEORIA",
"state": "IL",
"postal_code": "616151180",
"telephone_number": "309-258-1574"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10302 N SCHOPP LN",
"city": "PEORIA",
"state": "IL",
"postal_code": "616151180",
"telephone_number": "309-258-1574"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIEFERT",
"first_name": "WADE",
"middle_name": "A",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-03-12",
"last_updated": "2022-03-12",
"certification_date": "2022-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051036934",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "3096792051",
"affiliation": "Y",
"endpointDescription": "fax",
"affiliationName": "Hy-Vee Inc",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "10302 N Schopp Ln",
"city": "Peoria",
"state": "IL",
"country_code": "US",
"postal_code": "616151180",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "3096792051",
"affiliation": "N",
"endpointDescription": "fax",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "10302 N Schopp Ln",
"city": "Peoria",
"state": "IL",
"country_code": "US",
"postal_code": "616151180",
"country_name": "United States",
"address_type": "DOM"
}
],
"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 Mar 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.