ILLINOIS PATHOLOGIST SERVICES, LLC (NPI# 1720218415) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720218415 |
| Entity Type | Organization |
| Organization Name | ILLINOIS PATHOLOGIST SERVICES, LLC |
| Practice Address |
800 Ne Glen Oak Ave Peoria IL 61603-3255 |
| Mailing Address |
5666 E State St Rockford IL 61108-2425 |
| Practice Telephone | 3096552850 |
| Mailing Telephone | 8152262000 |
| Enumeration Date | 2009-07-16 |
| Last Update Date | 2009-07-16 |
| Authorized Official Name | JAMES M MOORE (CEO) |
| 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 | 207ZP0105X |
Pathology Specialization: Clinical Pathology/Laboratory Medicine |
Allopathic & Osteopathic Physicians |
| Street Address |
800 NE GLEN OAK AVE |
| City | PEORIA |
| State | IL |
| Zip Code | 61603-3255 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760582266 | John Whittington | Family Medicine | 800 Ne Glen Oak Ave, Peoria, IL 61603-3255 | 2006-09-24 |
| 1619577657 | Natalie Ann Stephens | Nurse Practitioner | 800 Ne Glen Oak Ave, Peoria, IL 61603-3255 | 2020-10-28 |
| 1073178786 | Nicholas Mueller Piening | Student in an Organized Health Care Education/Training Program | 800 Ne Glen Oak Ave, Peoria, IL 61603-3255 | 2019-05-08 |
| 1114581204 | Sherri Lynn Alvarez | Physical Therapist | 800 Ne Glen Oak Ave, Peoria, IL 61603-3255 | 2019-04-24 |
| 1669871901 | Tina Nguyen Gannuscio | Pharmacist | 800 Ne Glen Oak Ave, Peoria, IL 61603-3255 | 2014-08-21 |
| 1477671592 | Osf Healthcare System | General Acute Care Hospital | 800 Ne Glen Oak Ave, Peoria, IL 61603-3255 | 2007-03-27 |
| 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 | 207ZP0105X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pathology |
| Specialization | Clinical Pathology/Laboratory Medicine |
| A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pathology, 2007. http://www.abpath.org/. American Osteopathic Board of Pathology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pathology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871095364 | Edward Doyle Slifer Sr. | Pathology | 2117 Greenside Drive, Spring Field, IL 62704 | 2018-03-01 |
| 1437272549 | Robert E. Merrick | Pathology | 1633 W Berwyn Ave, Chicago, IL 60640-2005 | 2007-04-06 |
| 1740201003 | Apl Clinical Pathology | Pathology | 800 E Carpenter, Springfield, IL 62769-0001 | 2006-07-22 |
| 1235163056 | Renuka Bhaskar | Pathology | 105 Krispy Kreme Dr, Ste 4, Bloomington, IL 61704-3751 | 2006-07-10 |
| 1881625341 | Winfield Laboratory Consultants, S.c. | Pathology | 25 Winfield Rd, Winfield, IL 60190 | 2006-07-05 |
| 1790747517 | Anjen Chenn | Pathology | 303 E Chicago Ave, Ward 3-200, Chicago, IL 60611-4296 | 2006-04-05 |
| 1720063217 | Roy M.y. Nomura | Pathology | 1270 Mercantile Dr, Highland, IL 62249-1256 | 2005-12-07 |
| 1801880976 | William K Drake | Pathology | 400 Caldwell, Staunton, IL 62088-1173 | 2005-09-06 |
| 1265433312 | Prairie Pathology and Laboratory Physicians | Pathology | Virginia At Franklin, Bromenn Regional Medical Center, Normal, IL 61761 | 2005-08-10 |
| 1598111403 | Kyle G Parker | Pathology | 5841 S Maryland Ave # Mc3083, Chicago, IL 60637-1447 | 2016-05-10 |
| 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.