Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
1 | 207Q00000X | Family Medicine | | | | No |
2 | 207R00000X | Internal Medicine | | | | No |
3 | 208000000X | Pediatrics | | | | No |
4 | 208100000X | Physical Medicine & Rehabilitation | | | | No |
5 | 208D00000X | General Practice | | | | No |
6 | 363A00000X | Physician Assistant | | | | No |
7 | 363L00000X | Nurse Practitioner | | | | No |
8 | 364S00000X | Clinical Nurse Specialist | | | | No |
9 | 207P00000X | Emergency Medicine | | | | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
1 | 8115303 | OTHER | | BCILLINOIS GROUP |
2 | CB8166 | MEDICARE ID-TYPE UNSPECIFIED | | RR MEDICARE GROUP |
3 | CH3653 | OTHER | ILLINOIS | RR MEDICARE GROUP |
4 | CB8514 | MEDICARE ID-TYPE UNSPECIFIED | | RR MEDICARE GROUP |
5 | 813590 | MEDICARE ID-TYPE UNSPECIFIED | | MEDICARE GROUP IL |
6 | 0219253 | MEDICAID | IOWA | |
7 | 92323 | OTHER | | BCWELLMARK WEST |
8 | 207197 | MEDICARE ID-TYPE UNSPECIFIED | | PA MEDICARE GROUP |
9 | 95149 | OTHER | | BCWELLMARK EKG GROUP |
10 | 91433 | OTHER | | BCWELLMARK E MOLINE |
11 | 54454 | MEDICARE UPIN | | |
12 | CK7064 | OTHER | IOWA | RR MEDICARE GROUP |
13 | 91471 | OTHER | | BCWELLMARK 7TH STREET |
14 | 97622 | OTHER | | BCWELLMARK MOLINE |