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MJM FAMILY MEDICINE SC
NPI 1093412686
Family Medicine in Peoria, IL

Active since February 14, 2023CLIA 14D2282254 · Waiver
900 MAIN ST STE 500, PEORIA, IL 61602(309) 672-4470(309) 672-4471 Get Directions Write a Review

NPPES record last updated: February 14, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Mjm Family Medicine Sc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MJM FAMILY MEDICINE SC (NPI 1093412686) is a healthcare organization registered as a family medicine in Peoria, Illinois and active in the NPI registry since February 2023. The organization holds a CLIA Waiver certificate valid through May 17, 2027 and lists Matthew J Mcmillin, Physician/owner, as its authorized official.

NPPES Registry Identity

NPI1093412686
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameMJM FAMILY MEDICINE SC
Location Address900 MAIN ST STE 500Peoria, IL 61602-5022
Mailing Address900 Main St Ste 500Peoria, IL 61602-5022 · (309) 672-4470 · Fax (309) 672-4471
Phone(309) 672-4470
Fax(309) 672-4471
Organization SubpartNo
Authorized OfficialMatthew J McmillinPhysician/owner · (309) 339-3469
Enumeration DateFebruary 14, 2023
NPPES CertifiedFebruary 14, 2023
✔ NPI 1093412686 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
900 MAIN ST STE 500, Peoria, IL 61602
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mjm Family Medicine Sc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Mjm Family Medicine Sc, which bills Medicare for the services this clinician delivers.

Clinician (1)

Matthew Mcmillin, MD
Family Practice
NPI 1528021987
221 NE GLEN OAK AVE
Peoria, IL 61603
(309) 672-5522
✔ PECOS✔ Accepts Medicare0.2 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 14D2282254

Mjm Family Medicine, Sc · Peoria, IL
Active · expires May 17, 2027
CLIA Number14D2282254
Laboratory TypePhysician Office
Certificate Effective DateMay 18, 2025
Certificate Expiration DateMay 17, 2027
Laboratory DirectorMatthew J. Mcmillin
Laboratory Phone(309) 570-1287
Laboratory LocationMjm Family Medicine, Sc10322 N Juliet Ct, Peoria, IL 61615
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mjm Family Medicine Sc's NPI number?

The NPI number for Mjm Family Medicine Sc is 1093412686. It was assigned to this organization in the NPPES registry on February 14, 2023.

Where is Mjm Family Medicine Sc located?

Mjm Family Medicine Sc is located at 900 Main St Ste 500, Peoria, IL 61602. The listed phone number is (309) 672-4470.

What is Mjm Family Medicine Sc's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Mjm Family Medicine Sc enrolled in Medicare?

Yes. Mjm Family Medicine Sc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Mjm Family Medicine Sc?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Family Practice) reassigns their Medicare billing to Mjm Family Medicine Sc. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Mjm Family Medicine Sc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D2282254) is associated with this NPI, valid through May 17, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Mjm Family Medicine Sc was last updated on February 14, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.