NPIMap

Organization Active NPI

Methodist Medical Center of Illinois

Doing business as MMG In School Health Peoria High

  • School Nurse Practitioner
  • Peoria, IL
National Provider Identifier
1780191437
Registry record updated Feb 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
School Nurse PractitionerTaxonomy code 363LS0200X
Legal business name
METHODIST MEDICAL CENTER OF ILLINOIS
Doing business as
MMG In School Health Peoria High
Practice address
1615 N North St
Peoria, IL 61604-4131
Phone
(309) 252-1020
Fax
(309) 281-1337
NPI assigned
Jan 3, 2018
Last updated
Feb 14, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2020

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

Authorized official

Name
Stephen M. Cirone
Title
Regional MGR-Reimb/Rev Recognition
Phone
(309) 672-4813

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
School Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LS0200X Primary

Addresses

Primary practice location

1615 N North St
Peoria, IL 61604-4131

Mailing address

5100 Reliable Pkwy
Chicago, IL 60686-0051

Other names 1

  • MMG In School Health Peoria High Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Methodist Medical Center Il11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1615 N North St
Peoria, IL 61604
Phone (309) 252-1020

NPI Registry JSON

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

{
    "created_epoch": "1514937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581638400000",
    "number": "1780191437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5100 RELIABLE PKWY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606860051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 N NORTH ST",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616044131",
            "telephone_number": "309-252-1020",
            "fax_number": "309-281-1337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METHODIST MEDICAL CENTER OF ILLINOIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-03",
        "last_updated": "2020-02-14",
        "certification_date": "2020-02-14",
        "status": "A",
        "authorized_official_last_name": "CIRONE",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "REGIONAL MGR-REIMB/REV RECOGNITION",
        "authorized_official_telephone_number": "309-672-4813"
    },
    "taxonomies": [
        {
            "code": "363LS0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, School",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MMG In School Health Peoria High",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MMG In School Health Peoria High",
            "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 Feb 14, 2020; 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.