ST JOSEPH MEDICAL CENTER (NPI# 1659552859) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659552859 |
| Entity Type | Organization |
| Organization Name | ST JOSEPH MEDICAL CENTER |
| Other Organization Name | OSF SAINT JOSEPH MEDICAL CENTER |
| Practice Address |
2200 E Washington St Bloomington IL 61701-4364 |
| Mailing Address |
800 Ne Glen Oak Ave Peoria IL 61603-3255 |
| Practice Telephone | 3096623311 |
| Enumeration Date | 2007-11-16 |
| Last Update Date | 2020-10-05 |
| Authorized Official Name | DIANE L MCGREW (PRESIDENT) |
| Authorized Official Telephone | 3096552850 |
| Is Organization Subpart | Y |
| Parent Organization Name | OSF HEALTHCARE SYSTEM |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207P00000X | Emergency Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BLUE CROSS BLUE SHIELD | 5715388 | 01 |
| IL | 000 | 05 |
| Other Name | Type Code |
|---|---|
| OSF Saint Joseph Medical Center | Doing Business As Name - Organization |
| ST JOSEPH MEDICAL CENTER EMERGENCY DEPT | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851330203 | St Joseph Medical Center | Home Health | 211 Landmark Dr, Suite D3, Normal, IL 61761-2160 | 2006-06-04 |
| 1871547414 | St Joseph Medical Center | Internal Medicine | 302 Saint Joseph Dr, Bloomington, IL 61701-3506 | 2006-05-19 |
| 1679012710 | St Joseph Medical Center | General Acute Care Hospital | 8441 State Highway 47, Suite 4300, Bryan, TX 77807-3207 | 2017-02-22 |
| 1336465004 | St Joseph Medical Center | General Acute Care Hospital | 1717 S J St, Tacoma, WA 98405-4933 | 2010-04-20 |
| 1174758346 | St Joseph Medical Center | Radiology | 407 E Vernon Ave, Normal, IL 61761-3813 | 2009-05-18 |
| 1902066400 | St Joseph Medical Center | Preventive Medicine | 1505 Eastland Dr, Suite 1000, Bloomington, IL 61701-3534 | 2008-06-10 |
| 1881782878 | St Joseph Medical Center | Internal Medicine | 1505 Eastland Dr, Suite 110, Bloomington, IL 61701-3534 | 2006-10-11 |
| 1184732851 | St Joseph Medical Center | General Acute Care Hospital | 2200 E Washington St, Bloomington, IL 61701-4364 | 2006-08-25 |
| 1932148236 | St Joseph Medical Center | Skilled Nursing Facility | 2200 E Washington St, Bloomington, IL 61701-4364 | 2006-06-05 |
| 1619916806 | St Joseph Medical Center | General Acute Care Hospital | 2200 E Washington St, Bloomington, IL 61701-4364 | 2006-06-05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | ST JOSEPH MEDICAL CENTER | 1717 S J St, Tacoma, WA 98405-4933 |
| Street Address |
2200 E WASHINGTON ST |
| City | BLOOMINGTON |
| State | IL |
| Zip Code | 61701-4364 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750383139 | Liza M. Pilch | Emergency Medicine | 2200 E Washington St, Bloomington, IL 61701-4364 | 2005-08-15 |
| 1154930436 | Tianna Elaine Marie Nicholas | Nurse Practitioner | 2200 E Washington St, Bloomington, IL 61701-4364 | 2020-07-23 |
| 1063040004 | Bailey Wilson | Occupational Therapist | 2200 E Washington St, Bloomington, IL 61701-4364 | 2020-03-27 |
| 1679104624 | Mark Garbek | Physician Assistant | 2200 E Washington St, Bloomington, IL 61701-4364 | 2020-01-29 |
| 1326688870 | Shannon Colleen Trosper | Nurse Practitioner | 2200 E Washington St, Bloomington, IL 61701-4364 | 2020-01-13 |
| 1174174536 | Ivanna Tiffany Yu | Physician Assistant | 2200 E Washington St, Bloomington, IL 61701-4364 | 2019-09-26 |
| 1912564634 | Hanna Marguerite Cresci | Speech-Language Pathologist | 2200 E Washington St, Bloomington, IL 61701-4364 | 2019-05-29 |
| 1730654336 | Samantha Schuckles | Physical Therapist | 2200 E Washington St, Bloomington, IL 61701-4364 | 2018-10-10 |
| 1447758107 | Theresa M Hill | Nurse Practitioner | 2200 E Washington St, Bloomington, IL 61701-4364 | 2018-01-29 |
| 1821527201 | Jacob Peter Holton | Emergency Medicine | 2200 E Washington St, Bloomington, IL 61701-4364 | 2017-06-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770140964 | County of Mclean | Community/Behavioral Health | 200 W Front St, 1st Floor Sw, C/o 200 W Front St, Suite 400f, Bloomington, IL 61701 | 2019-05-22 |
| 1023525292 | Karli Johnson | Counselor | 200 W Monroe St Ste C7, Bloomington, IL 61701 | 2018-01-09 |
| 1487172409 | Melody Ann Bauman | Physician Assistant | 1505 Eastland Dr, Osf Critical Cane, Pulmonary, Sleep M, Bloomington, IL 61701 | 2017-08-30 |
| 1215396288 | Heidi Larsen | Social Worker | 902 S East St, Bloomington, IL 61701 | 2016-02-18 |
| 1558735126 | Andrea E. Andrews Counseling LLC | Counselor | 200 W. Monroe St., Ste 302 C, Bloomington, IL 61701 | 2015-11-19 |
| 1174924856 | Carole Hahn | Dietitian, Registered | 1406 Forrest St, Bloomington, IL 61701 | 2014-09-12 |
| 1558786392 | Valerie Colleen Parker | Counselor | 109 W. Mulberry St., Bloomington, IL 61701 | 2014-03-04 |
| 1124459219 | Matilde Francois | Surgery | 1505 Eastland Dr Ste 2300, Bloomington, IL 61701 | 2013-11-27 |
| 1922435114 | Smitha H Shivaprasad | Pharmacist | 2611 East Oakland Avenue, Bloomington, IL 61701 | 2013-10-02 |
| 1295161941 | Ashvin Patel | Obstetrics & Gynecology | 31 Country Club Pl, Bloomington, IL 61701 | 2013-09-25 |
| Find all providers in zip 61701 | ||||
| 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 |
|---|---|---|---|---|
| 1710181664 | Obidike Richard Akahara | Emergency Medicine | 1129 Devonshire Curv, Bloomington, MN 55431-5016 | 2007-06-13 |
| 1801826235 | M Allan Griffith | Emergency Medicine | 1701 East College Ave, Bloomington, IL 61701 | 2006-07-03 |
| 1639109945 | Emergency Medicine Professionals of Indiana LLC | Emergency Medicine | 4011 So Monroe Medical Park Blvd, Bloomington, IN 47403-9765 | 2006-07-03 |
| 1326076654 | David Gill | Emergency Medicine | 24 Conway Cir, Bloomington, IL 61704-8285 | 2006-06-28 |
| 1184691362 | Steven Timothy Tvedte | Emergency Medicine | 5409 Mount Normandale Curv, Bloomington, MN 55437-1019 | 2006-03-07 |
| 1598730152 | Carson R Harris | Emergency Medicine | 8040 Old Cedar Ave S Ste 100, Bloomington, MN 55425-1205 | 2006-02-17 |
| 1962474809 | Jonathan D Slater | Emergency Medicine | 2705 Degarmo Dr, Bloomington, IL 61704-9177 | 2006-02-04 |
| 1487634226 | Luis A Martinez | Emergency Medicine | 4300 Marketpointe Dr Ste 100, Bloomington, MN 55435 | 2006-01-18 |
| 1043297278 | Ronald C Jenson | Emergency Medicine | 4794 Red Oak Ln, Bloomington, IN 47401-9100 | 2005-12-29 |
| 1801871934 | Emergency Physicians Professional Association | Emergency Medicine | 4300 Marketpointe Drive, Suite 100, Bloomington, MN 55435-5435 | 2005-12-13 |
| Find all providers in BLOOMINGTON | ||||
| City | BLOOMINGTON |
| Zip Code | 61701 |
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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.