Illinois Valley Podiatry Group PC

Primary specialty

PodiatristTaxonomy code 213E00000X

Legal business name

ILLINOIS VALLEY PODIATRY GROUP PC

Practice address

3322 W Willow Knolls
Peoria, IL 61614

Phone

(309) 691-5800

Fax

(309) 691-1336

NPI assigned

Apr 16, 2007

Last updated

Feb 21, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Thomas Kevin Brattain, DPMNPI 1285613463

Title

Podiatrist

Phone

(309) 691-5800

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• Illinois Valley Podiatry Other name

Locations

Practitioners 1

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.

• Thomas Kevin Brattain, DPM

  • Podiatrist
  • Peoria, IL
  • NPI 1285613463
  Authorized official Same address or phone

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361404800000",
    "number": "1750506846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3322 W WILLOW KNOLLS",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "61614",
            "telephone_number": "309-691-5800",
            "fax_number": "309-691-1336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3322 W WILLOW KNOLLS",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "61614",
            "telephone_number": "309-691-5800",
            "fax_number": "309-691-1336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS VALLEY PODIATRY GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-16",
        "last_updated": "2013-02-21",
        "status": "A",
        "authorized_official_last_name": "BRATTAIN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "KEVIN",
        "authorized_official_title_or_position": "PODIATRIST",
        "authorized_official_telephone_number": "309-691-5800",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0007215174",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CM5560",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Illinois Valley Podiatry",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Podiatrist in Peoria, IL
• Providers in Peoria, IL by specialty
• Podiatrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2013; 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.