Active NPI
Haig Hagop Manougian, M.D.
- Pediatrics Physician
- Peoria, IL
National Provider Identifier
1932761194
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 125.075242
- Practice address
- 530 NE Glen Oak Avenue
Peoria, IL 61637 - Phone
- (309) 655-2274
- Fax
- (309) 655-2565
- NPI assigned
- Jul 8, 2019
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 125.075242 | IL | Primary |
Addresses
Primary practice location
530 NE Glen Oak Avenue
Peoria, IL 61637
Mailing address
530 NE Glen Oak Avenue
Peoria, IL 61637
Phone (309) 655-2274
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20191113000944 | IL | Order and Referring Only - Pediatric Medicine | 5698107696 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125.075242 | IL | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1562544000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1581552000000",
"number": "1932761194",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "530 NE GLEN OAK AVENUE",
"city": "PEORIA",
"state": "IL",
"postal_code": "61637",
"telephone_number": "309-655-2274",
"fax_number": "309-655-2565"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "530 NE GLEN OAK AVENUE",
"city": "PEORIA",
"state": "IL",
"postal_code": "61637",
"telephone_number": "309-655-2274",
"fax_number": "309-655-2565"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANOUGIAN",
"first_name": "HAIG",
"middle_name": "HAGOP",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-07-08",
"last_updated": "2020-02-13",
"certification_date": "2020-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IL",
"license": "125.075242",
"primary": true
}
],
"identifiers": [],
"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 Feb 13, 2020; 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.