Individual provider Active NPI

Javier E. Fajardo, M.D.

  • Obstetrics & Gynecology Physician
  • Peoria, IL
National Provider Identifier
1902943780
Registry record updated Aug 31, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
036-117247 Issued in IL
Practice address
2419 W Cornerstone CT
Peoria, IL 61614-2529
Phone
(309) 692-2025
NPI assigned
Jan 31, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 036-117247 IL Primary
Obstetrics & Gynecology Physician 207V00000X 036117247 IL

Addresses

Primary practice location

2419 W Cornerstone CT
Peoria, IL 61614-2529

Mailing address

2023 Vadalabene Dr
Ste 200
Maryville, IL 62062-5636
Phone (618) 288-7408

Other practice location 1

8201 E Riverside Blvd
Rockford, IL 61114-2300
Phone (815) 971-7000

Other practice location 2

1045 W Stephenson St
Freeport, IL 61032-4864
Phone (815) 599-6000

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
I20210812002695 IL Practitioner - Obstetrics/Gynecology 0941304265 Reassigns benefits to 4 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-117247ILMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Anthony Health Affiliates CurrentSince May 1, 2022 Accepting new patients
For Women, LTD Obstetrics & Gynecology Current Accepting new patients
Pathology Services Illinois, LTD Current Accepting new patients
Christina L Midkiff MD SC CurrentSince Mar 1, 2022 Accepting new patients
Rockford Health Physicians CurrentSince Dec 11, 2023 Accepting new patients
Saint Anthony Health Affiliates CurrentSince May 1, 2022 Accepting new patients
RMH Pathologists, LTD Current Accepting new patients
Obhg Illinois SC Obstetrics & Gynecology CurrentSince Jul 22, 2022 Accepting new patients

Locations

4177 S Archer Ave
Chicago, IL 60632
Phone (773) 254-2222

5140 N California Ave
Chicago, IL 60625
Phone (773) 275-8811

29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652

2001 S California Ave
Chicago, IL 60608
Phone (773) 484-1201

2875 W 19th St
Chicago, IL 60623
Phone (773) 484-4300

1555 N Barrington Rd
Hoffman Estates, IL 60169
Phone (847) 490-2923

2023 Vadalabene Dr
Ste 200
Maryville, IL 62062
Phone (618) 288-7408

734 Cambridge Blvd
O Fallon, IL 62269
Phone (618) 622-6196

2300 N Rockton Ave
Rockford, IL 61103
Phone (815) 971-5510

8201 E Riverside Blvd
Rockford, IL 61114
Phone (815) 971-4066

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788134400000",
    "number": "1902943780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2023 VADALABENE DR",
            "address_2": "STE 200",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620625636",
            "telephone_number": "618-288-7408",
            "fax_number": "618-288-7418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2419 W CORNERSTONE CT",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616142529",
            "telephone_number": "309-692-2025"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8201 E Riverside Blvd",
            "address_purpose": "LOCATION",
            "city": "Rockford",
            "state": "IL",
            "postal_code": "611142300",
            "country_code": "US",
            "telephone_number": "815-971-7000",
            "fax_number": "815-968-7830",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1045 W Stephenson St",
            "address_purpose": "LOCATION",
            "city": "Freeport",
            "state": "IL",
            "postal_code": "610324864",
            "country_code": "US",
            "telephone_number": "815-599-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAJARDO",
        "first_name": "JAVIER",
        "middle_name": "E.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-31",
        "last_updated": "2026-08-31",
        "certification_date": "2026-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IL",
            "license": "036-117247",
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IL",
            "license": "036117247",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.