Individual provider Active NPI

Rujuta Gore

  • Ophthalmology Physician
  • Peoria, IL
National Provider Identifier
1720546559
Registry record updated Oct 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
036.161999 Issued in IL
Practice address
4927 N Glen Park Place Rd
Peoria, IL 61614-4676
Phone
(309) 308-3500
NPI assigned
Mar 11, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 036.161999 IL Primary
Pediatric Ophthalmology and Strabismus Specialist Physician 207WX0110X 036.161999 IL

Addresses

Primary practice location

4927 N Glen Park Place Rd
Peoria, IL 61614-4676

Mailing address

4927 N Glen Park Place Rd
Peoria, IL 61614-4676
Phone (309) 308-3500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221010003114 IL Practitioner - Ophthalmology 3476939729 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Board of Trustees of the University of IllinoisGroup PAC ID 3072422716, 1,134 clinicians

Practice addresses (Care Compare)

1 Illini Dr
Peoria, IL 61605-2576
Phone (309) 671-3173

Hospital & facility affiliations

  • Saint Francis Medical Center Hospital, Peoria, IL, CCN 140067

Merit-based Incentive Payment System (MIPS)

Final score
93.28 of 100Reported as group
Quality
73.53
Promoting interoperability
100
Improvement activities
40
Cost
70.73

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036.161999ILMDPediatric Ophthalmology and Strabismus Specialist Physician Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Osf Multi-Specialty Group CurrentSince Jun 1, 2025 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
The Board of Trustees of the University of Illinois Current Accepting new patients
The Board of Trustees of the University of Illinois CurrentSince Sep 16, 2022 Accepting new patients
Board of Trustees of the University of Illinois CurrentSince Sep 16, 2022 Accepting new patients

Locations

7694 Solutions Ctr
Chicago, IL 60677

3315 N Seminary St
Galesburg, IL 61401
Phone (309) 344-1000

1 Illini Dr
Peoria, IL 61605
Phone (309) 671-3000

1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

530 NE Glen Oak Ave
Peoria, IL 61637
Phone (309) 655-2553

4927 N Glen Park Place Rd
Peoria, IL 61614
Phone (309) 308-3500

Interoperability endpoints

  • Direct secure messaging: rgore537474@direct.hopkinsmedicine.org

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1552262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664582400000",
    "number": "1720546559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4927 N GLEN PARK PLACE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144676",
            "telephone_number": "309-308-3500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4927 N GLEN PARK PLACE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144676",
            "telephone_number": "309-308-3500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORE",
        "first_name": "RUJUTA",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-11",
        "last_updated": "2022-10-01",
        "certification_date": "2022-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "IL",
            "license": "036.161999",
            "primary": true
        },
        {
            "code": "207WX0110X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Pediatric Ophthalmology and Strabismus Specialist",
            "state": "IL",
            "license": "036.161999",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.