NPIMap

Organization Active NPI

Michael D. Tarantino, M.D. S.C.

  • Pediatric Hematology & Oncology Physician
  • Peoria, IL
National Provider Identifier
1740430784
Registry record updated Jul 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Hematology & Oncology PhysicianTaxonomy code 2080P0207X
Legal business name
MICHAEL D. TARANTINO, M.D. S.C.
Practice address
427 W Northmoor Rd
Peoria, IL 61614-3542
Phone
(309) 692-5337
Fax
(309) 693-3913
NPI assigned
Sep 26, 2008
Last updated
Jul 15, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2022

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

Authorized official

Name
Mr. Michael D. Tarantino, M.D.NPI 1396731063
Title
Medical Director
Phone
(309) 370-6124

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Hematology & Oncology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2080P0207X Primary

Addresses

Primary practice location

427 W Northmoor Rd
Peoria, IL 61614-3542

Mailing address

2 Old Farm LN
Washington, IL 61571-9733
Phone (309) 370-6124

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090205000359 IL Part B Supplier - Clinic/Group Practice 6800950833 Receives reassigned benefits from 15 practitioners
Practice locations: Peoria, IL

National Provider Directory

National Provider Directory

Locations

427 W Northmoor Rd
Peoria, IL 61614
Phone (309) 692-5337

6811 N Knoxville Ave
Ste A
Peoria, IL 61614
Phone (309) 692-5337

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1222387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657843200000",
    "number": "1740430784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 OLD FARM LN",
            "city": "WASHINGTON",
            "state": "IL",
            "postal_code": "615719733",
            "telephone_number": "309-370-6124",
            "fax_number": "309-693-3913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "427 W NORTHMOOR RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616143542",
            "telephone_number": "309-692-5337",
            "fax_number": "309-693-3913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL D. TARANTINO, M.D. S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-26",
        "last_updated": "2022-07-15",
        "certification_date": "2022-07-15",
        "status": "A",
        "authorized_official_last_name": "TARANTINO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "309-370-6124",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2080P0207X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": null,
            "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 Jul 15, 2022; 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.