Eagle Family Medicine SC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

EAGLE FAMILY MEDICINE SC

Practice address

2809 W Willow Knolls Suite C
Peoria, IL 61614-8259

Phone

(309) 692-6604

Fax

(309) 692-6492

NPI assigned

Mar 2, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Robert Scott Bevill, MDNPI 1700886280

Title

Physician President

Phone

(309) 692-6604

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Robert Scott Bevill, MD

  • Family Medicine Physician
  • Brimfield, IL
  • NPI 1700886280
  NPD (past) Authorized official

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

{
    "created_epoch": "1172793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215648000000",
    "number": "1659409290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2809 W WILLOW KNOLLS SUITE C",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616148259",
            "telephone_number": "309-692-6604",
            "fax_number": "309-692-6492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2809 W WILLOW KNOLLS SUITE C",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616148259",
            "telephone_number": "309-692-6604",
            "fax_number": "309-692-6492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE FAMILY MEDICINE SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-02",
        "last_updated": "2008-07-10",
        "status": "A",
        "authorized_official_last_name": "BEVILL",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "PHYSICIAN    PRESIDENT",
        "authorized_official_telephone_number": "309-692-6604",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "208745",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER NUMBER",
            "identifier": "K37812",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amy M Durst, APN
• Mona Marie Dworsack, AU.D., CCC-A, FAAA
• Melissa J. Dye
• Cody Dykes, CRNA
• Sarah Dynia
• Caitlyn Nicole Easley, APRN
• Easter Seals - Ucp
• Easter Seals - Ucp
• Easter Seals Ucp
• Anna Eastman, LCSW

• Primary Care Clinic/Center in Peoria, IL
• Providers in Peoria, IL by specialty
• Primary Care Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2008; 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.