SUSAN M METTILLE (NPI# 1790727410) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790727410 |
| Entity Type | Individual |
| Full Name | SUSAN M METTILLE |
| Credential | PA-C |
| Practice Address |
2805 N Knoxville Ave Peoria IL 61604-2869 |
| Practice Telephone | 3096249400 |
| Practice Fax Number | 3096242280 |
| Mailing Telephone | 3096249400 |
| Mailing Fax Number | 3096242280 |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2008-02-19 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | IL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | MEDICARE GROUP # | 208846 | 01 |
| IL | MEDICARE - GROUP # | 809840 | 01 |
| Street Address |
2805 N KNOXVILLE AVE |
| City | PEORIA |
| State | IL |
| Zip Code | 61604-2869 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639168222 | Gloria Isabel Diaz | Internal Medicine | 2805 N Knoxville Ave, Peoria, IL 61604-2869 | 2005-10-17 |
| 1982985339 | Scott A Gonia | Clinical Nurse Specialist | 2805 N Knoxville Ave, Peoria, IL 61604-2869 | 2011-08-30 |
| 1306020334 | Erica M Deford | Physician Assistant | 2805 N Knoxville Ave, Peoria, IL 61604-2869 | 2007-12-27 |
| 1467575092 | Melissa J. Dye | Clinical Nurse Specialist | 2805 N Knoxville Ave, Peoria, IL 61604-2869 | 2007-04-09 |
| 1912097205 | Michael F. Shekleton | Internal Medicine | 2805 N Knoxville Ave, Peoria, IL 61604-2869 | 2006-10-15 |
| 1447351077 | Fritz-henry Volmar | Internal Medicine | 2805 N Knoxville Ave, Suite 209, Peoria, IL 61604-2869 | 2006-09-26 |
| 1881635605 | Michael D Cashman | Internal Medicine | 2805 N Knoxville Ave, Peoria, IL 61604-2869 | 2006-06-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205357928 | Nydia I Rodriguez | Nurse's Aide | 3305 N Finnell Ave, Peoria, IL 61604 | 2017-07-03 |
| 1720327976 | Brin Diagnostics Inc. | Clinical Medical Laboratory | 3216 W Kenwood, West Peoria, IL 61604 | 2013-02-07 |
| 1225373715 | Ngocyen Thi Ngo | Pharmacist | 2515 N Knoxville Avenue, Peoria, IL 61604 | 2012-12-10 |
| 1194027003 | Schelly Chiropractic, Inc | Chiropractor | 1208 W Loucks, Peoria, IL 61604 | 2010-11-29 |
| 1770755852 | Dental Sealants & More | Dentist | 2126 N. University St., Peoria, IL 61604 | 2008-03-28 |
| 1821266123 | David L Krick | Dentist | 2022 N University, Peoria, IL 61604 | 2008-02-20 |
| 1568658409 | Advanced Physicians Health Care, S.c. | Chiropractor | 1200 West Loucks Ave, Peoria, IL 61604 | 2007-09-24 |
| 1902006000 | Noel Liu | Dentist | 3127 N. University St., Unit C, Peoria, IL 61604 | 2007-07-18 |
| 1568586386 | Susan B Bordenave-bishop | Dentist | 2116 N. Sheridan, Peoria, IL 61604 | 2007-03-19 |
| 1174689897 | Paul Anthony Amodeo | Dentist | 3100 N Dries Lane, Suite 301, Peoria, IL 61604 | 2006-12-28 |
| Find all providers in zip 61604 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275148280 | Patricia Miriam Rus | Physician Assistant | 23615 N 105th Dr, Peoria, AZ 85383-1195 | 2020-09-15 |
| 1083235154 | Katlyn Coyer | Physician Assistant | 900 Main St Ste 530, Peoria, IL 61602-1005 | 2020-04-30 |
| 1114586690 | Courtney A Hitpas | Physician Assistant | 3120 N Bigelow St, Peoria, IL 61604-1628 | 2019-06-10 |
| 1689137671 | Jeffrey Benjamin Miessau | Physician Assistant | 7707 N Knoxville Ave Ste 200, Peoria, IL 61614-2020 | 2019-04-08 |
| 1417413337 | Michelle Nemeh | Physician Assistant | 6760 W Thunderbird Rd Ste 100, Peoria, AZ 85381-5048 | 2019-02-15 |
| 1730655572 | Sylwia M. Budzik | Physician Assistant | 8600 Illinois Rt. 91, Suite 300, Peoria, IL 61615 | 2018-10-19 |
| 1962977538 | Ashley Deyoung | Physician Assistant | 13943 N 91st Ave Ste F101, Peoria, AZ 85381-3689 | 2018-10-09 |
| 1326557141 | Melissa L. Kingston | Physician Assistant | 13760 N 93rd Ave Ste 201, Peoria, AZ 85381-4200 | 2017-09-25 |
| 1396196465 | Ayla Diamond | Physician Assistant | 9165 W Thunderbird Rd Ste 200, Peoria, AZ 85381-4847 | 2016-06-29 |
| 1336530948 | Carolina C. Castro | Physician Assistant | 13128 N. 94th Drive, Suite 100, Peoria, AZ 85381-4252 | 2015-02-18 |
| 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.