Active NPI
Virginia Mattern
- Pharmacist
- Peoria Heights, IL
National Provider Identifier
1932482015
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051038152
- Practice address
- 1200 E War Memorial Dr
Peoria Heights, IL 61616-7723 - Phone
- (309) 682-3844
- NPI assigned
- Sep 24, 2011
- Last updated
- Sep 24, 2011
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051038152 | IL | Primary |
Addresses
Primary practice location
1200 E War Memorial Dr
Peoria Heights, IL 61616-7723
Mailing address
814 Grandview Way
Germantown Hills, IL 61548-9139
Phone (309) 383-2547
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051038152 | IL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
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": "1316822400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316822400000",
"number": "1932482015",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "814 GRANDVIEW WAY",
"city": "GERMANTOWN HILLS",
"state": "IL",
"postal_code": "615489139",
"telephone_number": "309-383-2547"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 E WAR MEMORIAL DR",
"city": "PEORIA HEIGHTS",
"state": "IL",
"postal_code": "616167723",
"telephone_number": "309-682-3844"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATTERN",
"first_name": "VIRGINIA",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-24",
"last_updated": "2011-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051038152",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria Heights, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.