Pediatrix Medical Group of Illinois PC

Primary specialty

Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X

Legal business name

PEDIATRIX MEDICAL GROUP OF ILLINOIS PC

Practice address

1401 E State St
Rockford, IL 61104-2315

Phone

(815) 489-4177

Fax

(815) 490-5906

NPI assigned

Sep 17, 2006

Organization subpart

No

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

Authorized official

Name

Arnold M Poole

Title

Signing Authority

Phone

(954) 384-0175

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1158451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517443200000",
    "number": "1902903610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 CONCORD TER",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333232815",
            "telephone_number": "800-243-3839",
            "fax_number": "844-686-2961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 E STATE ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611042315",
            "telephone_number": "815-489-4177",
            "fax_number": "815-490-5906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIX MEDICAL GROUP OF ILLINOIS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-17",
        "last_updated": "2018-02-01",
        "status": "A",
        "authorized_official_last_name": "POOLE",
        "authorized_official_first_name": "ARNOLD",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "SIGNING AUTHORITY",
        "authorized_official_telephone_number": "954-384-0175"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Prakash Pedapati
• Christine M Pedersen, MSPT
• Pediatric Associates of Rockford
• Pediatric Cardiology Associates of Northern Illinois SC
• Pediatric Dentistry of Northern Illinois LTD
• Anastasia Peer-Drake
• Kevin J Peifer, M.D.
• Pilar Romsos Peigh, MA, CCC/SLP
• Heidi Sue Pena, APRN
• Melinda Annette Pena, APNP

• Neonatal-Perinatal Medicine Physician in Rockford, IL
• Providers in Rockford, IL by specialty
• Neonatal-Perinatal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.