Dennis J Crnkovich, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036078560 Issued in IL

Practice address

200 E Pennsylvania Ave
Suite 105
Peoria, IL 61603-3089

Phone

(309) 655-7888

Fax

(309) 655-7905

NPI assigned

Feb 17, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1140134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391385600000",
    "number": "1831164409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E PENNSYLVANIA AVE",
            "address_2": "SUITE 105",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616033089",
            "telephone_number": "309-655-7888",
            "fax_number": "309-655-7905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 E PENNSYLVANIA AVE",
            "address_2": "SUITE 105",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616033089",
            "telephone_number": "309-655-7888",
            "fax_number": "309-655-7905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRNKOVICH",
        "first_name": "DENNIS",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-17",
        "last_updated": "2014-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036078560",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036078560",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Peoria, IL
• Providers in Peoria, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2014; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.