NPIMap

Organization Active NPI

The Antioch Group, Inc.

  • Psychologist
  • Peoria, IL
National Provider Identifier
1801993142
Registry record updated Oct 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
071-004483 Issued in IL
Legal business name
THE ANTIOCH GROUP, INC.
Practice address
6615 N. Big Hollow Rd.
Peoria, IL 61615-2451
Phone
(309) 692-6622
NPI assigned
Sep 20, 2006
Last updated
Oct 3, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2024

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

Authorized official

Name
Shelley Wilson
Title
Credentialing/Billing Specialist
Phone
(309) 692-6622

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X 071-004483 IL Primary

Addresses

Primary practice location

6615 N. Big Hollow Rd.
Peoria, IL 61615-2451

Mailing address

6615 N. Big Hollow Rd.
Peoria, IL 61615-2451
Phone (309) 692-6622

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040329000526 IL Part B Supplier - Clinic/Group Practice 8224920764 Receives reassigned benefits from 11 practitioners
Practice locations: Peoria, IL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 19

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.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727913600000",
    "number": "1801993142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6615 N. BIG HOLLOW RD.",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616152451",
            "telephone_number": "309-692-6622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6615 N. BIG HOLLOW RD.",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616152451",
            "telephone_number": "309-692-6622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE ANTIOCH GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2024-10-03",
        "certification_date": "2024-10-03",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "SHELLEY",
        "authorized_official_title_or_position": "CREDENTIALING/BILLING SPECIALIST",
        "authorized_official_telephone_number": "309-692-6622"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "IL",
            "license": "071-004483",
            "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 Oct 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.