Individual provider Active NPI

May C Sun, D.O.

  • Pediatrics Physician
  • Peoria, IL
National Provider Identifier
1629365424
Registry record updated Jun 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
125.059816 Issued in IL
Practice address
2401 W Alta Rd Apt 905
Peoria, IL 61615-1290
Phone
(858) 672-1851
NPI assigned
Jun 30, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 30, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 125.059816 IL Primary

Addresses

Primary practice location

2401 W Alta Rd Apt 905
Peoria, IL 61615-1290

Mailing address

2401 W Alta Rd Apt 905
Peoria, IL 61615-1290
Phone (858) 672-1851

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
I20141101000001 IL Practitioner - Pediatric Medicine 9234350406 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125.059816ILMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Proctor Health Systems CurrentSince Jan 15, 2024 Accepting new patients

Locations

5401 N Knoxville Ave
Ste 400
Peoria, IL 61614
Phone (309) 691-6610

Interoperability endpoints

  • Direct secure messaging: msundo388565@carlehiedirect.net

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.

NPI Registry JSON

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

{
    "created_epoch": "1309392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1309392000000",
    "number": "1629365424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 W ALTA RD APT 905",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616151290",
            "telephone_number": "858-672-1851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 W ALTA RD APT 905",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616151290",
            "telephone_number": "858-672-1851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUN",
        "first_name": "MAY",
        "middle_name": "C",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-06-30",
        "last_updated": "2011-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "125.059816",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.