NPIMap

Organization Active NPI

Pekin Hospital

  • Emergency Medical Services (Emergency Medicine) Physician
  • Pekin, IL
National Provider Identifier
1679698054
Registry record updated Jul 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X
License
0001834 Issued in IL
Legal business name
PEKIN HOSPITAL
Practice address
600 So 13TH Street
Pekin, IL 61554
Phone
(309) 353-0406
Fax
(309) 347-1240
NPI assigned
Mar 21, 2007
Last updated
Jul 6, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2012

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

Authorized official

Name
Gary Jepson
Title
Ceo
Phone
(309) 353-0756

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 0001834 IL
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X 0001834 IL Primary

Addresses

Primary practice location

600 So 13TH Street
Pekin, IL 61554

Mailing address

600 So 13TH Street
Pekin, IL 61554
Phone (309) 353-0406

Other identifiers 1

IdentifierTypeStateIssuer
0009015677OtherILBLUE CROSS PROFESSIONAL F

National Provider Directory

National Provider Directory
Tax ID family
Pekin Hospital-Crna4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341532800000",
    "number": "1679698054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 SO 13TH STREET",
            "city": "PEKIN",
            "state": "IL",
            "postal_code": "61554",
            "telephone_number": "309-353-0406",
            "fax_number": "309-347-1240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 SO 13TH STREET",
            "city": "PEKIN",
            "state": "IL",
            "postal_code": "61554",
            "telephone_number": "309-353-0406",
            "fax_number": "309-347-1240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEKIN HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2012-07-06",
        "status": "A",
        "authorized_official_last_name": "JEPSON",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "309-353-0756"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "0001834",
            "primary": false
        },
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "IL",
            "license": "0001834",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROFESSIONAL F",
            "identifier": "0009015677",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pekin, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2012; 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.