NPIMap

Organization Active NPI

Definitive Neurodiagnostics LLC

  • Electroneurodiagnostic Specialist/Technologist
  • Normal, IL
National Provider Identifier
1659490761
Registry record updated Jun 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Electroneurodiagnostic Specialist/TechnologistTaxonomy code 246ZE0600X
License
036100906 Issued in IL
Legal business name
DEFINITIVE NEURODIAGNOSTICS LLC
Practice address
1604 Visa Dr
Suite 1
Normal, IL 61761-2195
Phone
(309) 454-1100
Fax
(309) 454-1107
NPI assigned
Mar 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2016

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

Authorized official

Name
Vikki L. Falls
Title
Managing Director
Phone
(309) 454-1100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Electroneurodiagnostic Specialist/TechnologistGroup: 193400000X SINGLE SPECIALTY GROUP 246ZE0600X 036100906 IL Primary

Addresses

Primary practice location

1604 Visa Dr
Suite 1
Normal, IL 61761-2195

Mailing address

1604 Visa Dr
Suite 1
Normal, IL 61761-2195
Phone (309) 454-1100

National Provider Directory

National Provider Directory

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466553600000",
    "number": "1659490761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1604 VISA DR",
            "address_2": "SUITE 1",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617612195",
            "telephone_number": "309-454-1100",
            "fax_number": "309-454-1107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1604 VISA DR",
            "address_2": "SUITE 1",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617612195",
            "telephone_number": "309-454-1100",
            "fax_number": "309-454-1107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEFINITIVE NEURODIAGNOSTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-28",
        "last_updated": "2016-06-22",
        "status": "A",
        "authorized_official_last_name": "FALLS",
        "authorized_official_first_name": "VIKKI",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "309-454-1100"
    },
    "taxonomies": [
        {
            "code": "246ZE0600X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist/Technologist, Other, Electroneurodiagnostic",
            "state": "IL",
            "license": "036100906",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Normal, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2016; 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.