Individual provider Active NPI

David Slagle, MD

  • Infectious Disease Physician
  • Peoria, IL
National Provider Identifier
1891763082
Registry record updated Jun 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
036086726 Issued in IL
Practice address
Dept of Internal Medicine
530 NE Glen Oak
Peoria, IL 61637-0001
Phone
(309) 655-3292
NPI assigned
Mar 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease Physician 207RI0200X 036086726 IL Primary

Addresses

Primary practice location

Dept of Internal Medicine
530 NE Glen Oak
Peoria, IL 61637-0001

Mailing address

1 Illini Dr
Peoria, IL 61605-2576
Phone (309) 671-8503

Other identifiers 3

IdentifierTypeStateIssuer
036086726MedicaidIL
IL01G3OtherILJOHN DEERE
07215036OtherILBCBS

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20050304000762 IL Practitioner - Infectious DiseasePractitioner - Internal Medicine 9032163712 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
The Board of Trustees of the University of Illinois Current Accepting new patients
Board of Trustees of the University of Illinois Infectious Disease CurrentSince Jul 1, 1993 Accepting new patients
The Board of Trustees of the University of Illinois CurrentSince Jul 1, 1993 Accepting new patients
University of Illinois Past Accepting new patients
University of Illinois Past Accepting new patients
University of Illinois Past Accepting new patients
University of Illinois Past Accepting new patients
University of Illinois Past Accepting new patients
University of Illinois Infectious Disease Past Accepting new patients
University of Illinois Past Accepting new patients

Locations

7694 Solutions Ctr
Chicago, IL 60677

1 Illini Dr
Peoria, IL 61605
Phone (309) 671-3000

222 NE Monroe St
Ste 904
Peoria, IL 61602
Phone (309) 224-5621

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

Organizations & group practices 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308268800000",
    "number": "1891763082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 ILLINI DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616052576",
            "telephone_number": "309-671-8503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "DEPT OF INTERNAL MEDICINE",
            "address_2": "530 NE GLEN OAK",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616370001",
            "telephone_number": "309-655-3292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SLAGLE",
        "first_name": "DAVID",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-14",
        "last_updated": "2011-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "IL",
            "license": "036086726",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036086726",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE",
            "identifier": "IL01G3",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "07215036",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.