Active NPI
Gary Fisk, PA
- Surgical Physician Assistant
- Peoria, IL
National Provider Identifier
1891708491
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- 085000405
- Practice address
- 5405 N Knoxville Ave
Peoria, IL 61614-5016 - Phone
- (309) 691-4410
- NPI assigned
- Aug 14, 2006
- 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 | 085000405 | IL | Primary |
Addresses
Primary practice location
5405 N Knoxville Ave
Peoria, IL 61614-5016
Mailing address
5405 N Knoxville Ave
Peoria, IL 61614-5016
Phone (309) 691-4410
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Heartcare Midwest | Past | Accepting new patients |
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.
-
- Rural Acute Care Hospital
- Bloomington, IL
- NPI 1477782845
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1891708491",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5405 N KNOXVILLE AVE",
"city": "PEORIA",
"state": "IL",
"postal_code": "616145016",
"telephone_number": "309-691-4410"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5405 N KNOXVILLE AVE",
"city": "PEORIA",
"state": "IL",
"postal_code": "616145016",
"telephone_number": "309-691-4410"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FISK",
"first_name": "GARY",
"name_prefix": "Mr.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "IL",
"license": "085000405",
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.