JOSEPH R PETERS (NPI# 1639108129) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639108129 |
| Entity Type | Individual |
| Full Name | JOSEPH R PETERS |
| Credential | D.O. |
| Practice Address |
530 Ne Glen Oak Ave Peoria IL 61637-0001 |
| Practice Telephone | 3096552553 |
| Practice Fax Number | 3096552602 |
| Mailing Telephone | 3096552000 |
| Mailing Fax Number | 3096557869 |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2007-07-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207P00000X | Emergency Medicine | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MEDICARE GROUP NO. | 800810 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003237124 | Joseph Peters | Social Worker | 407 Kelly Rd, Wilmington, NC 28409-3155 | 2013-12-16 |
| 1013097559 | Joseph I Peters Jr. | Social Worker | 145 W Pearl St, Newark, NY 14513-1063 | 2006-10-17 |
| 1225058407 | Joseph A Peters | Family Medicine | 8917 Highway 57, Counce, TN 38326 | 2006-07-20 |
| 1942273545 | Joseph R Peters | Optometrist | 164 W 3rd St, Delta, CO 81416-1842 | 2006-02-13 |
| 1891778585 | Joseph Edward Peters | Psychologist | 92 Amherst Ave, Pueblo, CO 81005-1627 | 2005-11-28 |
| 1871159012 | Joseph Benedict Peters | Counselor | 4000 San Ernesto Ave, Anchorage, AK 99508-2874 | 2019-05-14 |
| 1902399298 | Joseph Conner Peters | Optometrist | 1875 Middle Rd, Bettendorf, IA 52722-3203 | 2018-06-11 |
| 1497063416 | Joseph Patrick Peters | Counselor | 2111 Champa St, Denver, CO 80205-2529 | 2010-09-24 |
| 1568577567 | Joseph Carter Peters | Ophthalmology | 3510 Martin Luther King Jr Blvd, Lynwood, CA 90262-2010 | 2006-08-20 |
| 1265474175 | Joseph Peters | Anesthesiology | 1521 Rainbow Dr, Gadsden, AL 35901-5395 | 2006-06-12 |
| Street Address |
530 NE GLEN OAK AVE |
| City | PEORIA |
| State | IL |
| Zip Code | 61637-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346235777 | Jack Michael Gibson | Obstetrics & Gynecology | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2005-09-12 |
| 1053912188 | Janie Clary | Nurse Practitioner | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-11-04 |
| 1265030548 | Christina David | Nurse Practitioner | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-10-09 |
| 1033726831 | Corry Lynn Rediger | Occupational Therapist | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-09-25 |
| 1720694094 | Katelynn M Madden | Clinical Nurse Specialist | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-09-21 |
| 1568074474 | Amanda Diane Beoletto | Pharmacist | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-08-21 |
| 1881212892 | Mohammad Mousbah Al-tabbaa | Student in an Organized Health Care Education/Training Program | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-07-07 |
| 1750909693 | Mohammad Gareeb | Student in an Organized Health Care Education/Training Program | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-07-07 |
| 1376160846 | Bassel Elia Abouzeid | Student in an Organized Health Care Education/Training Program | 530 Ne Glen Oak Ave, Peoria, IL 61637 | 2020-07-01 |
| 1700403516 | Christina Marie Spurgeon | Nurse Practitioner | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-06-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780200865 | Kuang Chuen Liu | Pediatrics | 530 Ne Glen Oak Ave, Peoria, Peoria, IL 61637 | 2020-06-24 |
| 1174184527 | Manisha Tharoor | Student in an Organized Health Care Education/Training Program | 530 N.e Glen Oak Ave, Peoria, IL 61637 | 2019-06-26 |
| 1609436724 | Sriviji Senthil Kumaran | Student in an Organized Health Care Education/Training Program | 530. N.e Glen Oak Ave., Peoria, IL 61637 | 2019-06-20 |
| 1780240929 | Abuzar Ali Asif | Student in an Organized Health Care Education/Training Program | 530 N. E. Glen Oak Ave., Peoria, IL 61637 | 2019-05-14 |
| 1518328665 | Jenna Bishop | Dietitian, Registered | 600 Ne Water Street, Peoria, IL 61637 | 2016-03-17 |
| 1194133850 | Ashish Kumar Roy | Internal Medicine | 530 N.e. Glen Oak Ave, Peoria, IL 61637 | 2014-07-25 |
| 1265720510 | Reuben Antony | Pediatrics | 530 Ne Glen Oak Ave., C/o Ms Suzy Lewellen, Peoria, IL 61637 | 2011-07-20 |
| 1366673436 | Joseph William Hauter | Emergency Medicine | 830 Ne Glen Oak Ave, Peoria, IL 61637 | 2009-08-06 |
| 1437380748 | Jeremy R Monroe | Emergency Medicine | 530 Glen Oak, Osf St Francis Medical Center, Peoria, IL 61637 | 2009-08-04 |
| 1326244682 | Maria S. Parr | Psychiatry & Neurology | Osf Saint Francis Medical Center, 530 N.e.glen Oak Ave., Peoria, FL 61637 | 2007-06-25 |
| Find all providers in zip 61637 | ||||
| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205367802 | Medexpress Urgent Care Illinois, P.C. | Emergency Medicine | 5038 N Big Hollow Road, Peoria, IL 61615-3510 | 2017-03-24 |
| 1285049296 | Julia Hutchison | Emergency Medicine | 530 Ne Glen Oak Ave # Sfnb2624, Peoria, IL 61637-0001 | 2014-06-27 |
| 1891134151 | Kyle Fletcher Brown | Emergency Medicine | Osf Saint Francis Medical Center 530 Ne Glen Oak Ave, North Building 2620, Peoria, IL 61637-0001 | 2013-06-20 |
| 1366673436 | Joseph William Hauter | Emergency Medicine | 830 Ne Glen Oak Ave, Peoria, IL 61637 | 2009-08-06 |
| 1437380748 | Jeremy R Monroe | Emergency Medicine | 530 Glen Oak, Osf St Francis Medical Center, Peoria, IL 61637 | 2009-08-04 |
| 1568624708 | Brandon C Begley | Emergency Medicine | 540 Ne Glen Oak Ave, Peoria, IL 61603 | 2008-06-30 |
| 1114119880 | Suhail Khan | Emergency Medicine | Osf Stfrancis Medical Center Dept of Emergency Medicine, 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2007-08-15 |
| 1962601351 | Tony Yun Hsu | Emergency Medicine | 3517 W Willow Knolls Dr, 1-f, Peoria, IL 61614-1090 | 2007-07-16 |
| 1053518092 | Michael M Raso | Emergency Medicine | 1115 N Bourland Ave, Peoria, IL 61606-1210 | 2007-07-02 |
| 1184670663 | Methodist Medical Center of Illinois | Emergency Medicine | 120 Ne Glen Oak Ave, Suite 101, Peoria, IL 61603 | 2006-05-26 |
| Find all providers in PEORIA | ||||
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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.