UNIVERSITY OF ILLINOIS (NPI# 1619948411) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619948411 |
| Entity Type | Organization |
| Organization Name | UNIVERSITY OF ILLINOIS |
| Other Organization Name | MEDICAL SERVICE PLAN AT PEORIA |
| Practice Address |
Regional Development Center 507 E Armstrong Peoria IL 61603 |
| Mailing Address |
1 Illini Dr Peoria IL 61605-2576 |
| Practice Telephone | 3096816960 |
| Mailing Telephone | 3096718503 |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | WILLIAM R NICHAOLAS (EXECUTIVE DIRECTOR OF MSP) |
| Authorized Official Telephone | 3124130573 |
| Authorized Official Credential | PHD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0006X |
Pediatrics Specialization: Developmental – Behavioral Pediatrics |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BCBS | 07215036 | 01 |
| Other Name | Type Code |
|---|---|
| Medical Service Plan at Peoria | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659431351 | University of Illinois | Public Health or Welfare | 2815 W Washington, Suite 300, Springfield, IL 62794-9481 | 2006-12-11 |
| 1861409450 | University of Illinois | Audiologist | 2001 S Oak St Ste B, Champaign, IL 61820-0912 | 2006-08-03 |
| 1962475996 | University of Illinois | Obstetrics & Gynecology | Dept. of Ob / Gyn, 530 Ne Glen Oak, Peoria, IL 61637-0001 | 2006-02-09 |
| 1174596225 | University of Illinois | Pediatrics | 515 Ne Glen Oak Ave, Pediatric Neurology, Peoria, IL 61603-3165 | 2006-02-09 |
| 1245203280 | University of Illinois | Psychiatry & Neurology | Department of Psychiatry, 221 Ne Glen Oak 7 West, Peoria, IL 61636-0001 | 2006-02-09 |
| 1568433050 | University of Illinois | Pediatrics | St Jude Midwest Affiliate, 530 Ne Glen Oak, Peoria, IL 61637-0001 | 2006-02-01 |
| 1275817249 | University of Illinois | General Acute Care Hospital | 611 W Park St, Carle Forum, Urbana, IL 61801-2500 | 2011-10-07 |
| 1871725028 | University of Illinois | Internal Medicine | 840 S Wood St, Department of Medicine, M/c 787, Chicago, IL 60612-4325 | 2009-08-20 |
| 1962631010 | University of Illinois | Psychologist | 1747 W Roosevelt Rd, Chicago, IL 60608-1264 | 2009-07-10 |
| 1205002185 | University of Illinois | General Acute Care Hospital | 611 W Park St, Carle Forum Lower Level, Urbana, IL 61801-2500 | 2008-05-01 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | UNIVERSITY OF ILLINOIS | 809 S Marshfield 9th Flr, Chicago, IL 60612-4305 |
| Oklahoma Business Registrations | UNIVERSITY OF ILLINOIS FOUNDATION | 1305 West Green St, Urbana, IL 61801 |
| System for Award Management (SAM) Entities | UNIVERSITY OF ILLINOIS RESEARCH PARK, LLC | 60 Hazelwood Dr, Champaign, IL 61820-7460 |
| Street Address |
REGIONAL DEVELOPMENT CENTER 507 E ARMSTRONG |
| City | PEORIA |
| State | IL |
| Zip Code | 61603 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114996014 | William Maurer | Pediatrics | Regional Development Center, 507 E Armstrong, Peoria, IL 61603 | 2006-03-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598362980 | Courtney Klein | Nurse Practitioner | 1306 N. Berkley Ave, Peoria, IL 61603 | 2020-10-08 |
| 1114588217 | Kong Xing Wang | Dentist | 320 East Armstrong Ave, Peoria, IL 61603 | 2019-06-28 |
| 1073015319 | Sara Kristine Rosenbery | Nurse Practitioner | 515 Ne Glen Oak Ave Ste 202, Peoria, IL 61603 | 2018-03-02 |
| 1861860058 | Jennifer Michelle Kelsey | Clinical Nurse Specialist | 420 Ne Glen Oak Avenue, Suite 401, Peoria, IL 61603 | 2015-09-04 |
| 1467859793 | Bonnie Lansing | Counselor | 617 N Gendale Avenue, Behavioral Health Adult Program, Peoria, IL 61603 | 2014-12-02 |
| 1639597172 | Jael K. Mahasi | Counselor | 1800 Ne Perry Avenue, Peoria, IL 61603 | 2014-04-02 |
| 1992054829 | Justin S Ferragut | Radiology | 530 Northeast Glen Oak Avenue, Peoria, IL 61603 | 2012-09-06 |
| 1780952994 | Syed Muhammad Tayyab | Internal Medicine | 828 Ne Glen Oak Ave Apt No208a, Peoria, IL 61603 | 2011-12-02 |
| 1528389079 | St. Francis Medical Center | General Acute Care Hospital | 530 N E Glen Oak Ave, Peoria, IL 61603 | 2010-06-18 |
| 1780810648 | Children's Home Association of Illinois | Voluntary or Charitable | 400 E. Frye, Peoria, IL 61603 | 2009-06-05 |
| Find all providers in zip 61603 | ||||
| Taxonomy Code | 2080P0006X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Developmental – Behavioral Pediatrics |
| A developmental-behavioral specialist is a pediatrician with special training and experience who aims to foster understanding and promotion of optimal development of children and families through research, education, clinical care and advocacy efforts. This physician assists in the prevention, diagnosis, and management of developmental difficulties and problematic behaviors in children and in the family dysfunctions that compromise children's development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source changed, 3/26/2008: definition corrected] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174597371 | Sue Clark | Pediatrics | 507 E Armstrong Ave, Regional Development Center, Peoria, IL 61603-3201 | 2006-02-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720625601 | Shane Rafferty | Pediatrics | 4852 N Rockwell St Apt 2, Chicago, IL 60625-6521 | 2019-12-10 |
| 1376930750 | Prudence Hartwell | Pediatrics | 5841 S Maryland Ave # Mc0900, Chicago, IL 60637 | 2015-04-23 |
| 1962841122 | Jessica Katz Edison | Pediatrics | 1555 Barrington Rd Lowr Level, Hoffman Estates, IL 60169-1019 | 2013-06-21 |
| 1942598891 | Sotiria E. Moschovis | Pediatrics | 6127 N. Leader Ave., Chicago, IL 60646 | 2011-07-13 |
| 1326335514 | Evora Juanita Brent | Pediatrics | 1000 Central St., Suite 800, Evanston, IL 60201-1780 | 2011-07-07 |
| 1720142995 | Peter Joseph Smith Sr. | Pediatrics | 950 E. 61st Street, Ssc, Suite 207, Chicago, IL 60637 | 2006-12-21 |
| 1912545542 | Neila Petrovic | Pediatrics | 603 E Diehl Rd Ste 123, Naperville, IL 60563-4908 | 2019-12-13 |
| 1538637905 | Isabel Krynski | Pediatrics | 740 Quail Ridge Dr, Westmont, IL 60559-6148 | 2018-11-05 |
| 1134644834 | Shevia Morris | Pediatrics | 5116 N Nordica Ave, Chicago, IL 60656-3606 | 2017-08-03 |
| 1982066957 | Maria Gabriela Balsa Guerrero | Pediatrics | 5841 S Maryland Ave # Mc8016, Chicago, IL 60637-1443 | 2016-03-28 |
| Find all providers with the same taxonomy | ||||
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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.