Glen Avenue Family Practice - Medicare Primary Care in Peoria, IL

Glen Avenue Family Practice is a medicare enrolled primary clinic (General Practice) in Peoria, Illinois. The current practice location for Glen Avenue Family Practice is 4930 N Executive Dr, Peoria, Illinois. For appointments, you can reach them via phone at (309) 692-7575. The mailing address for Glen Avenue Family Practice is 4930 N Executive Dr, Peoria, Illinois and phone number is (309) 692-7575.

Glen Avenue Family Practice is licensed to practice in Illinois (license number 036067626). The clinic also participates in the medicare program and its NPI number is 1689896961. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (309) 692-7575.

Contact Information

Glen Avenue Family Practice
4930 N Executive Dr
Peoria
IL 61614-4894
(309) 692-7575
Not Available

Map and Direction


Primary Care Clinic Profile

Full NameGlen Avenue Family Practice
SpecialityGeneral Practice
Location4930 N Executive Dr, Peoria, Illinois
Authorized Official Name and PositionSusan Lafollette (BILLING MANAGER)
Authorized Official Contact3096718749
Accepts Medicare InsuranceYes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Glen Avenue Family Practice
4930 N Executive Dr
Peoria
IL 61614-4894

Ph: (309) 692-7575
Glen Avenue Family Practice
4930 N Executive Dr
Peoria
IL 61614-4894

Ph: (309) 692-7575

NPI Details:

NPI Number1689896961
Provider Enumeration Date05/03/2007
Last Update Date06/30/2008

Medicare PECOS Information:

Medicare PECOS PAC ID3678594777
Medicare Enrollment IDO20051216000498

Medical Identifiers

Medical identifiers for Glen Avenue Family Practice such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1689896961NPI-NPPES
212719OtherILMEDICARE GROUP ID

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
208D00000XGeneral Practice 036067626 (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. Glen Avenue Family Practice acts as a billing entity for following providers:
Provider NameSyed Masood Ali
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1700805439
PECOS PAC ID: 2769403864
Enrollment ID: I20051216000549

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Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.