Channing Petrak, MD in Peoria, IL

Channing Petrak, MD is a medicare enrolled "Pediatrics" physician in Peoria, Illinois. Her current practice location is Dept Of Pediatrics, 320 E Armstrong, Peoria, Illinois. You can reach out to her office (for appointments etc.) via phone at (309) 624-9587.

Channing Petrak is licensed to practice in Illinois (license number 036108511) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1952370538.

Contact Information

	Channing Petrak, MD
	Dept Of Pediatrics, 320 E Armstrong, Peoria, IL 61603
	(309) 624-9587
	Not Available

Map and Direction

Physician's Profile

Full Name	Channing Petrak
Gender	Female
Speciality	Pediatrics
Location	Dept Of Pediatrics, Peoria, Illinois
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1952370538
Provider Enumeration Date: 03/16/2006
Last Update Date: 07/22/2013

Medicare PECOS Information:

PECOS PAC ID: 6103055652
Enrollment ID: I20140204001250

Medical Identifiers

Medical identifiers for Channing Petrak such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1952370538	NPI	-	NPPES
036108511	Medicaid	IL
639810	Other	IL	MEDICARE PTAN
07215036	Other	IL	BCBS
IL01CN	Other	IL	JOHN DEERE

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
208000000X	Pediatrics	036108511 (Illinois)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Channing Petrak allows following entities to bill medicare on her behalf.

Entity Name	The Board Of Trustees Of The University Of Illinois
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1386863819 PECOS PAC ID: 3072422716 Enrollment ID: O20031112000158

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Channing Petrak is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Channing Petrak, MD 1 Illini Dr, Peoria, IL 61605-2576 Ph: (309) 671-8503	Channing Petrak, MD Dept Of Pediatrics, 320 E Armstrong, Peoria, IL 61603 Ph: (309) 624-9587

Reviews and Comments

Pediatrics Doctors in Peoria, IL

Thomas James Mcmorrow, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-655-2553 Fax: 309-655-2602
Jessica Ford-davis, D.O. Pediatrics Medicare: Medicare Enrolled Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-655-2274
Kelsey Elizabeth Grimes, DO Pediatrics Medicare: Medicare Enrolled Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-655-2000
Jessica N Mistretta, DO Pediatrics Medicare: Medicare Enrolled Practice Location: 8600 State Route 91 Ste 200, Peoria, IL 61615 Phone: 309-692-1030 Fax: 309-691-3241
Mrs. Valeria Claudia Benavides Lopez, M.D., M.P.H. Pediatrics Medicare: Medicare Enrolled Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-624-3313
Dr. Gretchen L Kopec, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-624-0615
Dr. Patrick Joseph Rizzuto Iii, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-671-3000

Channing Petrak, MD - Medicare Pediatrics in Peoria, IL