Brian Bostwick, MD
Individual provider Active NPI Pediatrics Physician · Springfield, IL
NPI 1891768636 · NPPES record last updated Oct 20, 2020
Key facts
- NPI
- 1891768636
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 036106503 (IL)
- Practice address
- 301 N 8TH St
Pav 4a
Springfield, IL 62702 - Phone
- (217) 545-8000
- Fax
- (217) 545-2303
- NPI assigned
- Feb 10, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 10
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040510001387 | IL | Practitioner - Pediatric Medicine |
2668461195 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036106503 | IL | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Siu Physicians & Surgeons, Inc | Current |
Accepting new patients | |
| The Board of Trustees of the University of Illinois | Current |
Accepting new patients | |
| Central PA Pharmacy LLC. | Current | Accepting new patients | |
| Board of Trustees of the University of Illinois | Internal Medicine | Current |
Accepting new patients |
| Osf Multi-Specialty Group | Internal Medicine | Current |
Accepting new patients |
| Siu Physicians & Surgeons, Inc | Internal Medicine | Current |
Accepting new patients |
| The Board of Trustees of the University of Illinois | Current | Accepting new patients | |
| Board of Trustees of Southern Illinois University | Current | Accepting new patients | |
| Siu Physicians & Surgeons, Inc | Pediatrics | Past | Accepting new patients |
| University of Illinois | Internal Medicine | Past | Accepting new patients |
Locations
7694 Solutions Ctr
Chicago, IL 60677
2 Memorial Dr
Fl 2
Decatur, IL 62526
530 NE Glen Oak Ave
Peoria, IL 61637
Phone (309) 655-2553
1 Illini Dr
Peoria, IL 61605
Phone (309) 671-3000
8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050
751 N Rutledge St
Springfield, IL 62702
Phone (217) 545-0182
201 E Madison St
Ste 300
Springfield, IL 62702
Phone (217) 545-7876
301 N 8th St
Springfield, IL 62701
Phone (217) 545-0003
Interoperability endpoints
- brianbostwick@siusm.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 036106503 | IL | |
| Pediatrics Physician | 208000000X | 036106503 | IL | Yes |
Addresses
Primary practice location
301 N 8TH St
Pav 4a
Springfield, IL 62702
Mailing address
530 NE Glen Oak Ave
Peoria, IL 61637-0001
Phone (309) 655-3292
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 07215036 | Other | IL | BCBS |
| IL0104 | Other | IL | JOHN DEERE |
| 036106503 | Medicaid | IL |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | brianbostwick@siusm.allscriptsdirect.net |
Other providers in Springfield, IL
- Julie Borjon
- Amanda J Bormann
- Jon M Bormann
- Tomasz W. Borowiecki
- William Scott Boston
- Jeffrey G. Bostwick
- Katherine L Bottom
- Kathleen M Bottum
- Alexes H Bouchard
- Caitlin L. Boucher
All providers in Springfield, IL · Pediatrics Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 20, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.