PAUL PEDERSEN (NPI# 1053403675) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053403675 |
| Entity Type | Individual |
| Full Name | PAUL PEDERSEN |
| Practice Address |
1701 E College Ave Bloomington IL 61704-2101 |
| Practice Telephone | 3096643120 |
| Practice Fax Number | 3096635742 |
| Mailing Telephone | 3096643120 |
| Mailing Fax Number | 3096635742 |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2020-10-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | 036-059949 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036059949 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003892720 | Paul Christen Pedersen | General Practice | 602 Knox St, Barbourville, KY 40906-1304 | 2005-12-15 |
| 1609386168 | Paul Mcarthur Pedersen | Social Worker | 6918 W Windsor Ave, Berwyn, IL 60402-3334 | 2017-10-10 |
| Street Address |
1701 E COLLEGE AVE |
| City | BLOOMINGTON |
| State | IL |
| Zip Code | 61704-2101 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982602140 | Brandy Lynn Redman | Occupational Therapist | 1701 E College Ave, Bloomington, IL 61704-2101 | 2005-07-12 |
| 1336777515 | Paula Roberts | Nurse Practitioner | 1701 E College Ave, Bloomington, IL 61704-2101 | 2020-04-01 |
| 1689150948 | Barbara Luann Weis | Psychiatry & Neurology | 1701 E College Ave, Bloomington, IL 61704-2101 | 2018-07-18 |
| 1366949224 | Kayla Marie Hnilicka | Registered Nurse | 1701 E College Ave, Bloomington, IL 61704-2101 | 2018-04-09 |
| 1992227052 | Christine C Gardner | Nurse Practitioner | 1701 E College Ave, Bloomington, IL 61704-2101 | 2017-07-11 |
| 1033652243 | Sonal Mukesh Patel | Nurse Practitioner | 1701 E College Ave, Bloomington, IL 61704-2101 | 2016-11-21 |
| 1285013029 | Andrew Tharp | Nurse Practitioner | 1701 E College Ave, Bloomington, IL 61704-2101 | 2015-05-27 |
| 1154670073 | Amy Lynn Nelson | Occupational Therapist | 1701 E College Ave, Bloomington, IL 61704-2101 | 2012-09-06 |
| 1336403237 | Derrick Alwyn Fox | Psychiatry & Neurology | 1701 E College Ave, Bloomington, IL 61704-2101 | 2012-06-26 |
| 1437434982 | Abbi Carr | Nurse Practitioner | 1701 E College Ave, Bloomington, IL 61704-2101 | 2011-10-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518430859 | Visionpoint Eye Center LLC | Optometrist | 1107 Airport Road, Bloomington, IL 61704 | 2019-01-09 |
| 1922588235 | Geethu Sabu Makil | Speech-Language Pathologist | 1039 Blueheron Way, Apt#3, Bloomington, IL 61704 | 2018-08-16 |
| 1629596812 | Mental Wellness Center Inc | Counselor | 202 N Prospect Rd Ste 207, Bloomington, IL 61704 | 2017-09-07 |
| 1649798513 | Sarah Goodner | Psychologist | 1704 Royal Pointe Drive, Bloomington, IL 61704 | 2017-08-31 |
| 1346760253 | Elizabeth Devlin | Nurse Practitioner | 25 Long Cove Ct, Bloomington, IL 61704 | 2017-06-21 |
| 1396107918 | Darla Schwertfeger | Specialist/Technologist, Other | 2104 Hedgewood Dr, Bloomington, IL 61704 | 2016-03-23 |
| 1740662949 | Oncology Hematology Associates of Central Illinois | Pharmacy | 3105 Magory Drive, Bloomington, IL 61704 | 2015-06-24 |
| 1821478967 | Kelly R Andrews | Massage Therapist | 4101 Wicker Rd, Bloomington, IL 61704 | 2015-06-03 |
| 1235522582 | All Ways Caring Services, Inc. | In Home Supportive Care | 209 S Prospect Rd, Suite 3e, Bloomington, IL 61704 | 2015-03-11 |
| 1396093977 | Bhawna Gupta | Physical Therapist | 2200 East Washington Street, Bloomington, IL 61704 | 2012-08-29 |
| Find all providers in zip 61704 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255857926 | Kare Clinic | Internal Medicine | 1696 W Hennessey St, Bloomington, IN 47403-4645 | 2017-08-15 |
| 1669756060 | Dhanasarn Mongkolsmai | Internal Medicine | 2206 Berrywood Ln, Bloomington, IL 61704-2448 | 2011-10-04 |
| 1982906566 | Guy H Waldo | Internal Medicine | 9133 S Front Nine Drive, Bloomington, IN 47401-8151 | 2010-12-02 |
| 1154556843 | Primary Care Specialists, LLC | Internal Medicine | 2 Airline Dr, Suite 500, Bloomington, IL 61704-3433 | 2009-05-25 |
| 1790922201 | John Leeper Mcnay Jr. | Internal Medicine | 2032 S. Ramsey Dr., Bloomington, IN 47401-7153 | 2009-01-21 |
| 1790947539 | Jared A Frazin | Internal Medicine | 9332 Rich Rd, Bloomington, MN 55437-2074 | 2008-07-01 |
| 1114124575 | Joseph Michael Mackey | Internal Medicine | 1011 West Second Street, Bloomington, IN 47403-2216 | 2007-06-29 |
| 1588867386 | Virgil D. Short | Internal Medicine | 326 Fairway Dr, Bloomington, IL 61701-3462 | 2007-06-08 |
| 1013086792 | Daniel R Berg Md PC | Internal Medicine | 2620 North Walnut Street, Suite 400, Bloomington, IN 47404 | 2006-11-07 |
| 1386736023 | Jerry Antonini | Internal Medicine | 1505 Eastland Drive, Suite 320, Bloomington, IL 61701-3534 | 2006-09-29 |
| Find all providers in BLOOMINGTON | ||||
| City | BLOOMINGTON |
| Zip Code | 61704 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.