NPIMap

Organization Active NPI

Midwest Orthopaedic Center S C

  • Specialist
  • Peoria, IL
National Provider Identifier
1710938006
Registry record updated Dec 31, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
MIDWEST ORTHOPAEDIC CENTER S C
Practice address
6000 N Allen Road
Peoria, IL 61614-3294
Phone
(309) 691-1400
NPI assigned
May 12, 2006
Last updated
Dec 31, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2019

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

Authorized official

Name
Mr. Derek Armstrong
Title
Coo
Phone
(309) 691-1400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU Primary

Addresses

Primary practice location

6000 N Allen Road
Peoria, IL 61614-3294

Mailing address

6000 N Allen Road
Peoria, IL 61614-3294
Phone (309) 691-1400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040106000226 IL Part B Supplier - Clinic/Group Practice 8022917715 Receives reassigned benefits from 52 practitioners
Practice locations: Peoria, IL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D0994661Midwest Orthopaedic Center S C6000 N Allen Road, Peoria, IL 61614Certificate of waiverFeb 10, 2027

National Provider Directory

National Provider Directory

Locations

2351 Broadway St
Pekin, IL 61554
Phone (309) 353-4159

5401 N Knoxville Ave
Ste 44
Peoria, IL 61614
Phone (309) 691-7914

6000 N Allen Rd
Peoria, IL 61614
Phone (309) 391-1400

8600 State Route 91
Ste 400
Peoria, IL 61615
Phone (309) 683-4300

Practitioners & affiliated clinicians

Practitioners 64

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.

View all 64

NPI Registry JSON

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577750400000",
    "number": "1710938006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6000 N ALLEN ROAD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616143294",
            "telephone_number": "309-691-1400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6000 N ALLEN ROAD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616143294",
            "telephone_number": "309-691-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST ORTHOPAEDIC CENTER S C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-12",
        "last_updated": "2019-12-31",
        "certification_date": "2019-12-31",
        "status": "A",
        "authorized_official_last_name": "ARMSTRONG",
        "authorized_official_first_name": "DEREK",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "309-691-1400",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.