Alan Debord, MD

Primary specialty

SpecialistTaxonomy code 174400000X

License

036055826 Issued in IL

Practice address

200 E Pennsylvania Ave
Peoria, IL 61603-3089

Phone

(309) 655-2045

Fax

(309) 655-3057

NPI assigned

May 2, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Osf Healthcare System

  • Certified Registered Nurse Anesthetist
  • Monmouth, IL
  • NPI 1811016124
  Medicare reassignment NPD
• Osf Healthcare System

  • General Acute Care Hospital
  • Dixon, IL
  • NPI 1508683590
  NPD
• Osf Healthcare System

  • Clinic/Center
  • Kewanee, IL
  • NPI 1699191841
  NPD
• Gibson Community Hospital Association

  • Critical Access Hospital
  • Gibson City, IL
  • NPI 1114935681
  NPD (past)
• Ozarks Medical Center

  • General Acute Care Hospital
  • West Plains, MO
  • NPI 1831115641
  NPD (past)

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

{
    "created_epoch": "1146528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326153600000",
    "number": "1902864796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E PENNSYLVANIA AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616033089",
            "telephone_number": "309-655-2045",
            "fax_number": "309-655-3057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 E PENNSYLVANIA AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616033089",
            "telephone_number": "309-655-2045",
            "fax_number": "309-655-3057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEBORD",
        "first_name": "ALAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-02",
        "last_updated": "2012-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": "036055826",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "809840",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE GROUP PTAN",
            "identifier": "CA4079",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE MEMBER PTAN",
            "identifier": "P00651196",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036055826",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Edna Elizabeth Dean, LCSW
• Ellyn Dearing, M.S., CFY-SLP
• Jenelle Deatherage, PT
• Elizabeth Debernardi, PT
• Deborah Simonis LCSW
• James R Debord, MD
• Anthony V Deceanne, DPM
• Arleta Dedianous, APRN
• Fizza Deen, MD
• Erica M Deford, PA

• Specialist in Peoria, IL
• Providers in Peoria, IL by specialty
• Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.