Active NPI
Scott Joseph Cicciarelli Jr.
- Surgical Physician Assistant
- Peoria, IL
National Provider Identifier
1801485271
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- 085008908
- Practice address
- 6000 N Allen Rd
Peoria, IL 61614-3294 - Phone
- (309) 691-1400
- Fax
- (309) 693-3197
- NPI assigned
- Jan 11, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 085008908 | IL | Primary |
Addresses
Primary practice location
6000 N Allen Rd
Peoria, IL 61614-3294
Mailing address
6000 N Allen Rd
Peoria, IL 61614-3294
Phone (309) 691-1400
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: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220624001724 | IL | Practitioner - Physician Assistant | 3870972656 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Saint Louis University School of Medicine, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Midwest Orthopaedic Center S C
Practice addresses (Care Compare)
6000 N Allen Rd
Peoria, IL 61614-3294
Phone (309) 691-1400
Hospital & facility affiliations
- Carle Health Methodist Hospital
- Saint Francis Medical Center
- Carle Health Proctor Hospital
- St Mary Medical Center
- Carle Health Pekin Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Organizations & group practices 1
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 5
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": "1610323200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655078400000",
"number": "1801485271",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6000 N ALLEN RD",
"city": "PEORIA",
"state": "IL",
"postal_code": "616143294",
"telephone_number": "309-691-1400",
"fax_number": "309-693-3197"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6000 N ALLEN RD",
"city": "PEORIA",
"state": "IL",
"postal_code": "616143294",
"telephone_number": "309-691-1400",
"fax_number": "309-693-3197"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CICCIARELLI",
"first_name": "SCOTT",
"middle_name": "JOSEPH",
"name_suffix": "Jr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-01-11",
"last_updated": "2022-06-13",
"certification_date": "2022-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "IL",
"license": "085008908",
"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 Jun 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.