Retina Consultants of Central Illinois, SC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

042-616854 Issued in IL

Legal business name

RETINA CONSULTANTS OF CENTRAL ILLINOIS, SC

Practice address

3310 West Chartwell Road
Suite 101
Peoria, IL 61614

Phone

(309) 693-2249

Fax

(309) 693-2583

NPI assigned

Jun 26, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Chittaranjan V. Reddy, MDNPI 1992737084

Title

Owner

Phone

(309) 693-2249

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 1

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

• Chittaranjan Venkat Reddy, MD

  • Ophthalmology Physician
  • Peoria, IL
  • NPI 1992737084

  IL, Ophthalmology

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534809600000",
    "number": "1689601940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1466",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530081466",
            "telephone_number": "262-788-9229",
            "fax_number": "262-788-9241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3310 WEST CHARTWELL ROAD",
            "address_2": "SUITE 101",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "61614",
            "telephone_number": "309-693-2249",
            "fax_number": "309-693-2583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RETINA CONSULTANTS OF CENTRAL ILLINOIS, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-26",
        "last_updated": "2018-08-21",
        "status": "A",
        "authorized_official_last_name": "REDDY",
        "authorized_official_first_name": "CHITTARANJAN",
        "authorized_official_middle_name": "V.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "309-693-2249",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "IL",
            "license": "036090651",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "IL",
            "license": "042-616854",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Peoria, IL
• Ophthalmology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.