NPIMap

Individual provider Active NPI

Derek Minor, MD

  • Surgery Physician
  • Peoria, IL
National Provider Identifier
1891315610
Registry record updated Aug 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
036175746 Issued in IL
Practice address
1001 Main St
Peoria, IL 61606-1907
Phone
(309) 495-0200
Fax
(309) 676-6545
NPI assigned
Apr 22, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 036175746 IL Primary

Addresses

Primary practice location

1001 Main St
Peoria, IL 61606-1907

Mailing address

PO Box 19248
Springfield, IL 62794-9248
Phone (217) 528-7541

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250714000318 IL Practitioner - General Surgery 1355761461 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Springfield Clinic, LLPGroup PAC ID 0547166076, 678 clinicians
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians
Mason Hospital DistrictGroup PAC ID 2466360607, shared by 5 NPIs, 41 clinicians

Practice addresses (Care Compare)

1001 Main St
Suite 300
Peoria, IL 61606-2036
Phone (217) 528-7541

2200 E Washington St
Bloomington, IL 61701-4364
Phone (309) 662-3311

600 S 13TH St
Pekin, IL 61554-4936
Phone (309) 349-1079

615 N Promenade St
Havana, IL 62644-1243
Phone (309) 543-8510

775 Engineering Ave
Springfield, IL 62703-5909
Phone (217) 522-4300

8600 State Route 91
Suite 130
Peoria, IL 61615-7829
Phone (309) 683-5050

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Melanoma (skin cancer) excision1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036175746ILMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Osf Multi-Specialty Group CurrentSince Jul 7, 2025 Accepting new patients
Loyola University Medical Center Current Accepting new patients
Springfield Clinic, LLP CurrentSince Jul 15, 2025 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients

Locations

210 Saint Joseph Dr
Bloomington, IL 61701
Phone (309) 663-5050

615 N Promenade St
Havana, IL 62644
Phone (309) 543-8510

600 S 13th St
Ste D
Pekin, IL 61554
Phone (309) 347-2700

1001 Main St
Ste 300
Peoria, IL 61606
Phone (309) 495-0200

7309 N Knoxville Ave
Peoria, IL 61614
Phone (309) 282-0827

530 NE Glen Oak Ave
Peoria, IL 61637
Phone (309) 655-2553

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

775 Engineering Ave
Springfield, IL 62703
Phone (217) 522-4300

Interoperability endpoints

  • Direct secure messaging: dminor161341@direct.luhs.org
  • Direct secure messaging: derek.minor.1@28977.direct.athenahealth.com

Organizations & group practices 4

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

Hospital & facility affiliations 7

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": "1587513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754956800000",
    "number": "1891315610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19248",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627949248",
            "telephone_number": "217-528-7541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 MAIN ST",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616061907",
            "telephone_number": "309-495-0200",
            "fax_number": "309-676-6545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINOR",
        "first_name": "DEREK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-22",
        "last_updated": "2025-08-12",
        "certification_date": "2025-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036175746",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.