Provider Demographics
NPI: | 1184670663 |
---|---|
Name: | METHODIST MEDICAL CENTER OF ILLINOIS |
Entity Type: | Organization |
Organization Name: | METHODIST MEDICAL CENTER OF ILLINOIS |
Other - Org Name: | METHODIST MEDICAL GROUP |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | REGIONAL MGR-REIMB/REV RECOGNITION |
Authorized Official - Prefix: | |
Authorized Official - First Name: | STEPHEN |
Authorized Official - Middle Name: | M |
Authorized Official - Last Name: | CIRONE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 309-672-4813 |
Mailing Address - Street 1: | 5100 RELIABLE PKWY |
Mailing Address - Street 2: | |
Mailing Address - City: | CHICAGO |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 60686-0051 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 120 NE GLEN OAK AVE |
Practice Address - Street 2: | SUITE 101 |
Practice Address - City: | PEORIA |
Practice Address - State: | IL |
Practice Address - Zip Code: | 61603 |
Practice Address - Country: | US |
Practice Address - Phone: | 309-671-8230 |
Practice Address - Fax: | 309-671-5118 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-05-26 |
Last Update Date: | 2020-02-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Single Specialty | |
No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Single Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Single Specialty | |
No | 207RG0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | Group - Single Specialty |
No | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | Group - Single Specialty |
No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Single Specialty |
No | 207VM0101X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | Group - Single Specialty |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Single Specialty | |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Single Specialty | |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Single Specialty |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Single Specialty |
No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Single Specialty |
No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IL | 7215059 | Other | BCBS PPO |
IL | 7215059 | Other | BCBS PPO |
IL | 211369 | Medicare ID - Type Unspecified | HLVI NP & PA |
IL | 827130 | Medicare ID - Type Unspecified | HLVI MD & DO |
IL | 206504 | Medicare ID - Type Unspecified | NP |
IL | 208268 | Medicare ID - Type Unspecified | PA, LCSW, PHD |