Individual provider Active NPI

Earl J Wipfler, M.D.

  • Emergency Medicine Physician
  • Peoria, IL
National Provider Identifier
1639284995
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Practice address
530 NE Glen Oak Ave
Peoria, IL 61637-0001
Phone
(309) 655-2553
Fax
(309) 655-2602
NPI assigned
Aug 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X IL Primary

Addresses

Primary practice location

530 NE Glen Oak Ave
Peoria, IL 61637-0001

Mailing address

530 NE Glen Oak Ave
Peoria, IL 61637-0001
Phone (309) 655-2000

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
I20040401001081 IL Practitioner - Emergency Medicine 3971595661 Reassigns benefits to 5 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-083938ILMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saint James Hospital CurrentSince Aug 1, 2005 Accepting new patients
Saint Francis Medical Center CurrentSince Jan 1, 1987 Accepting new patients
Saint Francis Medical Center Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Dec 1, 2020 Accepting new patients
Osf Healthcare System Current Accepting new patients
Osf Healthcare System CurrentSince Nov 1, 2013 Accepting new patients
Saint James Hospital CurrentSince Aug 1, 2005 Accepting new patients
Osf Healthcare System CurrentSince Nov 1, 2013 Accepting new patients
Saint Francis Medical Center CurrentSince Jan 1, 1987 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients

Locations

1000 W Harlem Ave
Monmouth, IL 61462
Phone (309) 734-1414

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

1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195

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

2500 W Reynolds St
Pontiac, IL 61764
Phone (815) 842-2828

Organizations & group practices 10

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": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1639284995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616370001",
            "telephone_number": "309-655-2000",
            "fax_number": "309-655-7869"
        },
        {
            "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": "616370001",
            "telephone_number": "309-655-2553",
            "fax_number": "309-655-2602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIPFLER",
        "first_name": "EARL",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.