Individual provider Active NPI

Brian Bostwick, MD

  • Pediatrics Physician
  • Springfield, IL
National Provider Identifier
1891768636
Registry record updated Oct 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
036106503 Issued in 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
Last updated
Oct 20, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036106503 IL
Pediatrics Physician 208000000X 036106503 IL Primary

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

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address brianbostwick@siusm.allscriptsdirect.net

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
I20040510001387 IL Practitioner - Pediatric MedicinePractitioner - Internal Medicine 2668461195 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036106503ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Board of Trustees of the University of Illinois CurrentSince Aug 1, 2003 Accepting new patients
Siu Physicians & Surgeons, Inc CurrentSince Apr 30, 2018 Accepting new patients
Board of Trustees of Southern Illinois University Current Accepting new patients
The Board of Trustees of the University of Illinois Current Accepting new patients
Board of Trustees of the University of Illinois Internal Medicine CurrentSince Aug 1, 2003 Accepting new patients
Siu Physicians & Surgeons, Inc Internal Medicine CurrentSince Apr 30, 2018 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Multi-Specialty Group Internal Medicine CurrentSince Jan 25, 2017 Accepting new patients
University of Illinois Internal Medicine Past Accepting new patients
Siu Physicians & Surgeons, Inc Pediatrics Past Accepting new patients

Locations

7694 Solutions Ctr
Chicago, IL 60677

2 Memorial Dr
Fl 2
Decatur, IL 62526

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

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

201 E Madison St
Ste 300
Springfield, IL 62702
Phone (217) 545-7876

301 N 8th St
Springfield, IL 62701
Phone (217) 545-0003

751 N Rutledge St
Springfield, IL 62702
Phone (217) 545-0182

Interoperability endpoints

  • Direct secure messaging: brianbostwick@siusm.allscriptsdirect.net

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1139529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603152000000",
    "number": "1891768636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616370001",
            "telephone_number": "309-655-3292",
            "fax_number": "309-655-7732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 N 8TH ST",
            "address_2": "PAV 4A",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "62702",
            "telephone_number": "217-545-8000",
            "fax_number": "217-545-2303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOSTWICK",
        "first_name": "BRIAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-10",
        "last_updated": "2020-10-20",
        "certification_date": "2020-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036106503",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036106503",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "brianbostwick@siusm.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "301 N 8th St",
            "address_2": "PAV 4A",
            "city": "Springfield",
            "state": "IL",
            "country_code": "US",
            "postal_code": "62702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.