NPIMap

Organization Active NPI

Mid-Central Ill Gastro

  • Gastroenterology Physician
  • Normal, IL
National Provider Identifier
1992845358
Registry record updated Aug 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
MID-CENTRAL ILL GASTRO
Practice address
2200 Jacobssen Dr
Suite B
Normal, IL 61761-5516
Phone
(309) 451-1123
Fax
(309) 451-1212
NPI assigned
Feb 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2008

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

Authorized official

Name
Stephen S Matter, M.D.
Title
President
Phone
(309) 451-1123

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X Primary

Addresses

Primary practice location

2200 Jacobssen Dr
Suite B
Normal, IL 61761-5516

Mailing address

2200 Jacobssen Dr
Suite B
Normal, IL 61761-5516
Phone (309) 451-1123

Other identifiers 3

IdentifierTypeStateIssuer
0360818161MedicaidIL
05725403OtherILBLUECROSS BLUESHIELD
0360788251MedicaidIL

Other names 1

  • Mid-Central ILL Gast LTD Other name

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219881600000",
    "number": "1992845358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 JACOBSSEN DR",
            "address_2": "SUITE B",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617615516",
            "telephone_number": "309-451-1123",
            "fax_number": "309-451-1212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 JACOBSSEN DR",
            "address_2": "SUITE B",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617615516",
            "telephone_number": "309-451-1123",
            "fax_number": "309-451-1212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-CENTRAL ILL GASTRO",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2008-08-28",
        "status": "A",
        "authorized_official_last_name": "MATTER",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "309-451-1123",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0360818161",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD",
            "identifier": "05725403",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0360788251",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mid-Central ILL Gast LTD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Normal, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2008; 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.