NPIMap

Organization Active NPI

Streator Chidlrens Clinic

  • Specialist
  • Streator, IL
National Provider Identifier
1720453202
Registry record updated Jun 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
036091951 Issued in IL
Legal business name
STREATOR CHIDLRENS CLINIC
Practice address
111 Spring St FL 5
Streator, IL 61364-3332
Phone
(815) 673-2353
Fax
(815) 673-2486
NPI assigned
Dec 9, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2022

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

Authorized official

Name
Ms. Keady Gillman
Title
Office Manager
Phone
(815) 673-2353

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 036091951 IL Primary
Primary Care Clinic/Center 261QP2300X

Addresses

Primary practice location

111 Spring St FL 5
Streator, IL 61364-3332

Mailing address

111 Spring St FL 5
Streator, IL 61364-3332
Phone (815) 673-2353

Other identifiers 1

IdentifierTypeStateIssuer
036091951MedicaidIL

Other names 1

  • Streator Children's Clinic Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL EMR Other

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1449619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656460800000",
    "number": "1720453202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 SPRING ST FL 5",
            "city": "STREATOR",
            "state": "IL",
            "postal_code": "613643332",
            "telephone_number": "815-673-2353",
            "fax_number": "815-673-2486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 SPRING ST FL 5",
            "city": "STREATOR",
            "state": "IL",
            "postal_code": "613643332",
            "telephone_number": "815-673-2353",
            "fax_number": "815-673-2486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STREATOR CHIDLRENS CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-09",
        "last_updated": "2022-06-29",
        "certification_date": "2022-06-29",
        "status": "A",
        "authorized_official_last_name": "GILLMAN",
        "authorized_official_first_name": "KEADY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "815-673-2353",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "IL",
            "license": "036091951",
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036091951",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "EMR",
            "affiliation": "N",
            "endpointDescription": "EMR",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "EMR",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "EMR",
            "address_1": "111 Spring St Fl 5",
            "city": "Streator",
            "state": "IL",
            "country_code": "US",
            "postal_code": "613643332",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Streator Children's Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Streator, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2022; 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.