Active NPI
Osf Multispecialty Group Peoria LLC
- Pediatric Cardiology Physician
- Peoria, IL
National Provider Identifier
1770744799
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Cardiology Physician
- Legal business name
- OSF MULTISPECIALTY GROUP PEORIA LLC
- Practice address
- 420 NE Glen Oak Ave
Ste 304
Peoria, IL 61603-3105 - Phone
- (309) 655-3453
- NPI assigned
- Jun 23, 2008
- Organization subpart
- Yes
- Parent organization
- OSF HEALTHCARE SYSTEM
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Sister Diane Marie McGrew
- Title
- President/Treasurer
- Phone
- (309) 655-2850
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Cardiology Physician | 2080P0202X | Primary |
Addresses
Primary practice location
420 NE Glen Oak Ave
Ste 304
Peoria, IL 61603-3105
Mailing address
420 NE Glen Oak Ave
Ste 304
Peoria, IL 61603-3105
Other names 1
- CHILDREN'S HOSPITAL OF ILLINOIS MEDICAL GROUP
National Provider Directory
National Provider Directory- Part of
- Eastland Med Plaza Surg
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
-
- Durable Medical Equipment & Medical Supplies
- Peoria, IL
- NPI 1093370108
Member Of
Locations
2404 E Empire St
Bloomington, IL 61704
Phone (309) 663-8275
420 NE Glen Oak Ave
Ste 30
Peoria, IL 61603
Practitioners & affiliated clinicians
Practitioners 4
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Acute Care Nurse Practitioner
- Peoria, IL
- NPI 1962757799
-
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
- Loma Linda, CA
- NPI 1285607986
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214179200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1415923200000",
"number": "1770744799",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "420 NE GLEN OAK AVE",
"address_2": "STE 304",
"city": "PEORIA",
"state": "IL",
"postal_code": "616033105"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 NE GLEN OAK AVE",
"address_2": "STE 304",
"city": "PEORIA",
"state": "IL",
"postal_code": "616033105",
"telephone_number": "309-655-3453"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "OSF MULTISPECIALTY GROUP PEORIA LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "OSF HEALTHCARE SYSTEM",
"enumeration_date": "2008-06-23",
"last_updated": "2014-11-14",
"status": "A",
"authorized_official_last_name": "MCGREW",
"authorized_official_first_name": "SISTER DIANE",
"authorized_official_middle_name": "MARIE",
"authorized_official_title_or_position": "PRESIDENT/TREASURER",
"authorized_official_telephone_number": "309-655-2850"
},
"taxonomies": [
{
"code": "2080P0202X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pediatrics, Pediatric Cardiology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "CHILDREN'S HOSPITAL OF ILLINOIS MEDICAL GROUP",
"code": "3",
"type": "Doing Business As"
}
]
}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 Nov 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.