Active NPI
Bernadine Brattain
- Surgical Technologist
- Peoria, IL
National Provider Identifier
1902078355
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Technologist
- Practice address
- 5401 N Knoxville Ave
Suite 400
Peoria, IL 61614-5098 - Phone
- (309) 692-6644
- NPI assigned
- Mar 26, 2008
- Sex
- Female
- 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 Technologist | 246ZS0410X | Primary |
Addresses
Primary practice location
5401 N Knoxville Ave
Suite 400
Peoria, IL 61614-5098
Mailing address
5401 N Knoxville Ave
Suite 400
Peoria, IL 61614
Phone (309) 692-6644
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7230175 | Other | IL | BCBS |
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1206489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1206489600000",
"number": "1902078355",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5401 N KNOXVILLE AVE",
"address_2": "SUITE 400",
"city": "PEORIA",
"state": "IL",
"postal_code": "61614",
"telephone_number": "309-692-6644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5401 N KNOXVILLE AVE",
"address_2": "SUITE 400",
"city": "PEORIA",
"state": "IL",
"postal_code": "616145098",
"telephone_number": "309-692-6644"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRATTAIN",
"first_name": "BERNADINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-03-26",
"last_updated": "2008-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "246ZS0410X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Technologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "7230175",
"state": "IL"
}
],
"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 Mar 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.