NPIMap

Organization Active NPI

Proctor Health Systems

Doing business as Proctor Medical Group, Chillicothe Family Practice

  • Primary Care Clinic/Center
  • Chillicothe, IL
National Provider Identifier
1740234533
Registry record updated Jun 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
PROCTOR HEALTH SYSTEMS
Doing business as
Proctor Medical Group, Chillicothe Family Practice
Practice address
210 N 4TH St
Chillicothe, IL 61523-2058
Phone
(309) 274-2108
Fax
(309) 274-6920
NPI assigned
May 19, 2006
Last updated
Jun 26, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
PROCTOR HEALTH SYSTEMSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 26, 2008

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

Authorized official

Name
Carrie Chiaravalle
Title
Director
Phone
(309) 689-6049

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

210 N 4TH St
Chillicothe, IL 61523-2058

Mailing address

5401 N Knoxville Ave
Suite 209
Peoria, IL 61614-5098
Phone (309) 689-6049

Other names 1

  • PROCTOR MEDICAL GROUP, CHILLICOTHE FAMILY PRACTICE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040227000906 IL Part B Supplier - Clinic/Group Practice 3476440173 Receives reassigned benefits from 378 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Galesburg, IL; Washington, IL; Spring Valley, IL; Princeton, IL; Peoria, IL; Pekin, IL; Morton, IL; Metamora, IL…

Other NPIs on the same Medicare enrollment 10

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Internal Medicine Asso

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214438400000",
    "number": "1740234533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5401 N KNOXVILLE AVE",
            "address_2": "SUITE 209",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616145098",
            "telephone_number": "309-689-6049",
            "fax_number": "309-689-6092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 N 4TH ST",
            "city": "CHILLICOTHE",
            "state": "IL",
            "postal_code": "615232058",
            "telephone_number": "309-274-2108",
            "fax_number": "309-274-6920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROCTOR HEALTH SYSTEMS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROCTOR HEALTH SYSTEMS",
        "enumeration_date": "2006-05-19",
        "last_updated": "2008-06-26",
        "status": "A",
        "authorized_official_last_name": "CHIARAVALLE",
        "authorized_official_first_name": "CARRIE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "309-689-6049"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROCTOR MEDICAL GROUP, CHILLICOTHE FAMILY PRACTICE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chillicothe, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2008; 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.