METHODIST MEDICAL CENTER OF ILLINOIS (NPI# 1164474755) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164474755 |
| Entity Type | Organization |
| Organization Name | METHODIST MEDICAL CENTER OF ILLINOIS |
| Practice Address |
221 Ne Glen Oak Ave Peoria IL 61636 |
| Mailing Address |
221 Ne Glen Oak Ave Gomp 100 Peoria IL 61636-0001 |
| Practice Telephone | 3096725522 |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2020-02-14 |
| Authorized Official Name | MR. STEPHEN M. CIRONE (MANAGER - REIMBURSEMENT RECOGNITION) |
| Authorized Official Telephone | 3096724813 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 282N00000X | General Acute Care Hospital | 0001594 | IL | Hospitals |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BLUE CROSS PROV. NUMBER | 0116 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780191437 | Methodist Medical Center of Illinois | Nurse Practitioner | 1615 N North St, Peoria, IL 61604-4131 | 2018-01-03 |
| 1629355060 | Methodist Medical Center of Illinois | Nurse Practitioner | 2702 W Krause Ave, Peoria, IL 61605-2905 | 2011-11-14 |
| 1124305636 | Methodist Medical Center of Illinois | Nurse Practitioner | 811 S Griswold St, Peoria, IL 61605-1458 | 2011-11-11 |
| 1184670663 | Methodist Medical Center of Illinois | Emergency Medicine | 120 Ne Glen Oak Ave, Suite 101, Peoria, IL 61603 | 2006-05-26 |
| 1265966048 | Methodist Medical Center of Illinois | Clinic/Center | 221 Ne Glen Oak Ave, Peoria, IL 61636-0001 | 2017-04-18 |
| 1447537881 | Methodist Medical Center of Illinois | Nurse Practitioner | 1419 S Folkers Ave, Peoria, IL 61605 | 2011-11-14 |
| 1326366790 | Methodist Medical Center of Illinois | Clinic/Center | 525 S Sweetbriar Dr, Chillicothe, IL 61523 | 2010-05-11 |
| 1407174873 | Methodist Medical Center of Illinois | Clinic/Center | 1112 5th St, Lacon, IL 61540 | 2010-05-11 |
| 1942528310 | Methodist Medical Center of Illinois | Clinic/Center | 223 E Main St, Princeville, IL 61559 | 2010-05-11 |
| 1710198379 | Methodist Medical Center of Illinois | Nurse Practitioner | 221 Ne Glen Oak Ave, Peoria, IL 61636-0001 | 2007-05-25 |
| Street Address |
221 NE GLEN OAK AVE |
| City | PEORIA |
| State | IL |
| Zip Code | 61636 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851384135 | John Alan Howerton | Pharmacist | 221 Ne Glen Oak Ave, Peoria, IL 61636-0001 | 2005-08-23 |
| 1437750130 | Vanezza Buendia | Physical Therapist | 221 Ne Glen Oak Ave, Peoria, IL 61636-0001 | 2020-11-08 |
| 1306443056 | Austyn Powers | Nurse Practitioner | 221 Ne Glen Oak Ave, Peoria, IL 61636-0001 | 2020-10-06 |
| 1396357091 | Christopher Legan | Counselor | 221 Ne Glen Oak Ave, Peoria, IL 61636-0001 | 2020-08-24 |
| 1417575853 | Joseph Babione | Psychologist | 221 Ne Glen Oak Ave, Peoria, IL 61636-0001 | 2020-07-13 |
| 1811512411 | Methodist | Counselor | 221 Ne Glen Oak Ave, Peoria, IL 61636-0001 | 2020-06-10 |
| 1760003230 | Alexandra Bryan | Dietitian, Registered | 221 Ne Glen Oak Ave, Peoria, IL 61636-0001 | 2020-05-06 |
| 1467080523 | Dustin Dariusz Pilat | Student in an Organized Health Care Education/Training Program | 221 Ne Glen Oak Ave, Peoria, IL 61636-5027 | 2020-04-01 |
| 1295363505 | Abigail Brea Sebald | Student in an Organized Health Care Education/Training Program | 221 Ne Glen Oak Ave, Peoria, IL 61636-0001 | 2020-03-31 |
| 1790313054 | Elizabeth Alexandra Edwards | Student in an Organized Health Care Education/Training Program | 221 Ne Glen Oak Ave, Peoria, IL 61636-0001 | 2020-03-31 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962767376 | Aman Deep Singh | Psychiatry & Neurology | 221 Ne Glen Oak Ave. 7 West, Dept. of Psych. and Behavior Health., Peoria, IL 61636 | 2012-07-11 |
| 1932490075 | Christine Ann Wigginton | Radiology | 221 Ne Glen Oak Ave Dept Of, Peoria, IL 61636 | 2011-04-24 |
| 1568901544 | Stephanie Ann Sullivan | Nurse Anesthetist, Certified Registered | Unity Point Health Methodist, 221 Ne Glen Oak Avenue, Peoria, IL 61636-0001 | 2017-02-23 |
| 1073066155 | Caroline Vanaman | Counselor | 221 Ne Glen Oak Ave # 7w, Peoria, IL 61636-0001 | 2016-07-26 |
| 1497141758 | Amber Hemminger | Registered Nurse | 200 Ne Glen Oak Ave, Peoria, IL 61636-0001 | 2015-04-13 |
| 1326288812 | Bradley Reatherford | Registered Nurse | 221 Northeast Ave, Peoria, IL 61636-0001 | 2009-02-24 |
| 1386784155 | Eric Hawkins | Anesthesiology | 22i Ne Glen Oak Ave, Methodist Medical Center Anesthesiology, Peoria, IL 61636-0001 | 2007-02-08 |
| 1386659241 | Central Illinois Radiological Associates, Ltd. | Radiology | Osf St Francis Medical Ctr, 530 N.e. Glen Oak, Peoria, IL 61636-0001 | 2006-07-29 |
| 1659345007 | Mary C Bruell | Social Worker | Dept of Psychiatry, 221 Ne Glen Oak 7 West, Peoria, IL 61636-0001 | 2006-02-14 |
| 1245203280 | University of Illinois | Psychiatry & Neurology | Department of Psychiatry, 221 Ne Glen Oak 7 West, Peoria, IL 61636-0001 | 2006-02-09 |
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| Taxonomy Code | 282N00000X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| An acute general hospital is an institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medical conditions, both surgical and non-surgical, to a wide population group. The hospital treats patients in an acute phase of illness or injury, characterized by a single episode or a fairly short duration, from which the patient returns to his or her normal or previous level of activity. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215376702 | Gajalakshmi Vaka, Md PC | General Acute Care Hospital | 7183 W Camino De Oro, Peoria, AZ 85383-3264 | 2013-06-18 |
| 1528389079 | St. Francis Medical Center | General Acute Care Hospital | 530 N E Glen Oak Ave, Peoria, IL 61603 | 2010-06-18 |
| 1184885485 | Osf St. Francis Medical Center | General Acute Care Hospital | 2401 W Alta Rd, Apt. 907, Peoria, IL 61615-1279 | 2008-06-19 |
| 1033116876 | Proctor Community Hospital | General Acute Care Hospital | 5409 N Knoxville Ave, Peoria, IL 61614-5016 | 2005-07-07 |
| 1801340781 | Vhs of Arrowhead, Inc. | General Acute Care Hospital | 26900 N Lake Pleasant Pkwy, Peoria, AZ 85383-1394 | 2016-08-09 |
| 1366858763 | Sue A Behrens | General Acute Care Hospital | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2014-07-07 |
| 1265787923 | Osf Saint Francis | General Acute Care Hospital | Osf Saint Francis Medical Ctr, 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2012-07-18 |
| 1144595992 | Osf Saint Francis Medical Center | General Acute Care Hospital | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2012-03-13 |
| 1790986735 | Edward Alan Hirsch | General Acute Care Hospital | 530 Ne Glen Oak Ave, Peoria, IL 61637-2082 | 2007-05-29 |
| 1477671592 | Osf Healthcare System | General Acute Care Hospital | 800 Ne Glen Oak Ave, Peoria, IL 61603-3255 | 2007-03-27 |
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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.