NPIMap

Organization Active NPI

Methodist Medical Center of Illinois

  • School Nurse Practitioner
  • Peoria, IL
National Provider Identifier
1629355060
Registry record updated Feb 14, 2020
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
2702 W Krause Ave
Peoria, IL 61605-2905
Phone
(309) 685-8390
NPI assigned
Nov 14, 2011
Last updated
Feb 14, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2020

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

Authorized official

Name
Stephen M. Cirone
Title
Regional MGR-Reimb/Rev Recognition
Phone
(309) 672-4813

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
School Nurse Practitioner 363LS0200X Primary

Addresses

Primary practice location

2702 W Krause Ave
Peoria, IL 61605-2905

Mailing address

5100 Reliable Pkwy
Chicago, IL 60686-0051

National Provider Directory

National Provider Directory
Tax ID family
East Peoria Multi Speci11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

2702 W Krause Ave
Peoria, IL 61605
Phone (309) 685-8390

NPI Registry JSON

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

{
    "created_epoch": "1321228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581638400000",
    "number": "1629355060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5100 RELIABLE PKWY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606860051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2702 W KRAUSE AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616052905",
            "telephone_number": "309-685-8390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METHODIST MEDICAL CENTER OF ILLINOIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-14",
        "last_updated": "2020-02-14",
        "certification_date": "2020-02-14",
        "status": "A",
        "authorized_official_last_name": "CIRONE",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "REGIONAL MGR-REIMB/REV RECOGNITION",
        "authorized_official_telephone_number": "309-672-4813"
    },
    "taxonomies": [
        {
            "code": "363LS0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, School",
            "state": null,
            "license": null,
            "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 Feb 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.