Proctor Community Hospital

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

PROCTOR COMMUNITY HOSPITAL

Doing business as

Proctor Hospital

Practice address

5401 N Knoxville Ave Ste 104
Peoria, IL 61614-5021

Phone

(309) 643-6205

Fax

(309) 999-5722

NPI assigned

Feb 24, 2020

Last updated

Feb 24, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Robert A. Quin

Title

Cfo

Phone

(309) 671-4893

Specialties & licenses 1

Addresses

Other names 1

• Proctor Hospital Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Proctor Community Hospital

  dba Proctor Hospital

  • General Acute Care Hospital
  • Peoria, IL
  • NPI 1033116876

  9537077391

  Same PAC ID
• Proctor Community Hospital

  • Rehabilitation Hospital Unit
  • Peoria, IL
  • NPI 1134826894

  9537077391

  Same PAC ID
• Proctor Community Hospital

  dba Proctor Hospital

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Peoria, IL
  • NPI 1518490036

  9537077391

  Same PAC ID

Locations

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

{
    "created_epoch": "1582502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582502400000",
    "number": "1861026478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5401 N KNOXVILLE AVE STE 104",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616145021",
            "telephone_number": "309-643-6205",
            "fax_number": "309-999-5722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5401 N KNOXVILLE AVE STE 104",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616145021",
            "telephone_number": "309-643-6205",
            "fax_number": "309-999-5722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROCTOR COMMUNITY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-24",
        "last_updated": "2020-02-24",
        "certification_date": "2020-02-24",
        "status": "A",
        "authorized_official_last_name": "QUIN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "309-671-4893",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Proctor Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Proctor Community Hospital (Proctor Hospital)
• Proctor Community Hospital (Proctor Home Care)
• Proctor Community Hospital (Proctor Hospital)
• Proctor Community Hospital (Proctor Hospital)
• Proctor Community Hospital (Proctor Hospital Skilled Nursing)
• Proctor Health Systems (Illinois Valley Center for Plastic Surgery)
• Proctor Health Systems
• Proctor Health Systems (Dennis Crnkovich MD, Robert Meister MD)
• Proctor Health Systems (Proctor Medical Group Renaldo Jacques MD)
• Proctor Health Systems (Heart of Illinois Rehabilitation)

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Peoria, IL
• Providers in Peoria, IL by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2020; 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.