Individual provider Active NPI

Lisa E. Snyder, MD

  • Physical Medicine & Rehabilitation Physician
  • Peoria, IL
National Provider Identifier
1790715092
Registry record updated Jun 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
036-073903 Issued in IL
Practice address
6501 N Sheridan Rd
Peoria, IL 61614-2932
Phone
(309) 692-8110
Fax
(309) 692-8673
NPI assigned
Jul 3, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 036-073903 IL Primary

Addresses

Primary practice location

6501 N Sheridan Rd
Peoria, IL 61614-2932

Mailing address

6501 N Sheridan Rd
Peoria, IL 61614-2932
Phone (309) 692-8110

Other identifiers 4

IdentifierTypeStateIssuer
009033OtherILHEALTH ALLIANCE PROVIDER
036073903MedicaidIL
250004431OtherILRAIL ROAD MEDICARE ID
370681567-02OtherILJOHN DEERE PROVIDER NUMBE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100728000220 IL Practitioner - Psychiatry 4880727890 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians
Advanced Physical Therapy Services, LTD.Group PAC ID 9133101462, shared by 5 NPIs, 216 clinicians

Practice addresses (Care Compare)

200 E Pennsylvania Ave
Peoria, IL 61603-3089
Phone (309) 624-4000

61 E Side SQ
Canton, IL 61520-2603
Phone (309) 649-1572

Hospital & facility affiliations

  • Saint Francis Medical Center Hospital, Peoria, IL, CCN 140067
  • Osf Saint Clare Medical Center Hospital, Princeton, IL, CCN 141337
  • Osf Saint Elizabeth MDL Ctr Hospital, Peru, IL, CCN 140110

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036-073903ILMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Osf Healthcare System CurrentSince Feb 27, 2017 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Healthcare System CurrentSince Feb 27, 2017 Accepting new patients
Osf Multi-Specialty Group CurrentSince Jul 1, 2016 Accepting new patients
Osf Healthcare System Current Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

180 S Main St
Canton, IL 61520
Phone (309) 647-5240

1051 W South St
Kewanee, IL 61443
Phone (309) 734-3141

3422 Court St
#A
Pekin, IL 61554
Phone (309) 477-6000

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

6501 N Sheridan Rd
Peoria, IL 61614
Phone (309) 692-8110

200 E Pennsylvania Ave
Peoria, IL 61603
Phone (309) 624-4000

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1276560000000",
    "number": "1790715092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6501 N SHERIDAN RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616142932",
            "telephone_number": "309-692-8110",
            "fax_number": "309-692-8673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6501 N SHERIDAN RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616142932",
            "telephone_number": "309-692-8110",
            "fax_number": "309-692-8673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SNYDER",
        "first_name": "LISA",
        "middle_name": "E.",
        "name_prefix": "Mrs.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-03",
        "last_updated": "2010-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "IL",
            "license": "036-073903",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE PROVIDER",
            "identifier": "009033",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036073903",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE ID",
            "identifier": "250004431",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE PROVIDER NUMBE",
            "identifier": "370681567-02",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.