ST. MARY'S HOSPITAL STREATOR HOSPITAL SISTERS OF THE 3RD ORDER ST FRAN
Complete NPI Record 1295732725
General Acute Care Hospital in Streator, IL

Active since June 30, 2005
111 SPRING ST, STREATOR, IL 61364(815) 673-2311(815) 673-4524 Get Directions

NPPES record last updated: June 13, 2012. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Complete NPI Dataset

This page contains the complete raw NPPES record for St. Mary's Hospital Streator Hospital Sisters Of The 3rd Order St Fran (NPI 1295732725), a general acute care hospital organization in Streator, IL. All 88 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.

Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, Markdown or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.

Registry File Document Utilities
NPI: 1295732725
Field 1/88
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Field 2/88
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: Not available
Field 3/88
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Organization Name Legal Business Name: ST. MARY'S HOSPITAL STREATOR HOSPITAL SISTERS OF THE 3RD ORDER ST FRAN
Field 4/88
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: 111 SPRING ST
Field 5/88
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City Name: STREATOR
Field 6/88
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: IL
Field 7/88
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code: 613643332
Field 8/88
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Country Code If outside U S : US
Field 9/88
The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
Provider Business Mailing Address Telephone Number: 8156732311
Field 10/88
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number: 8156734524
Field 11/88
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Provider First Line Business Practice Location Address: 111 SPRING ST
Field 12/88
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: STREATOR
Field 13/88
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: IL
Field 14/88
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 613643332
Field 15/88
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
Field 16/88
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 8156732311
Field 17/88
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 8156734524
Field 18/88
The fax number associated with the location address of the provider being identified.
Authorized Official Last Name: CLARK
Field 21/88
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: KAREN
Field 22/88
The first name of the authorized official.
Authorized Official Middle Name: S
Field 23/88
The middle name of the authorized official.
Authorized Official Title or Position: CHIEF FINANCIAL OFFICER
Field 24/88
The title or position of the authorized official.
Authorized Official Telephone Number: 8156732311
Field 25/88
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 282N00000X
Field 26/88
This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: 0002659
Field 27/88
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with "provider taxonomy code".
Provider License Number State Code 1: IL
Field 28/88
The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.
Healthcare Provider Primary Taxonomy Switch 1: Y
Field 29/88
This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Other Provider Identifier 1: 3573
Field 30/88
An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 1: 01
Field 31/88
A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 1: IL
Field 32/88
The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier Issuer 1: HEALTH ALLIANCE ID
Field 33/88
The name of the organization, agency, or health plan that assigned the additional provider identifier. This identifies who issued the number linked to Other Provider Identifier 1 (for example, a state Medicaid agency, Medicare, or a private insurance company).
Other Provider Identifier 2: =========001
Field 34/88
An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 2: 05
Field 35/88
A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 2: IL
Field 36/88
The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier 3: A6136401
Field 37/88
An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 3: 01
Field 38/88
A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 3: IL
Field 39/88
The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier Issuer 3: UNITED HEALTHCARE RIVER
Field 40/88
The name of the organization, agency, or health plan that assigned the additional provider identifier. This identifies who issued the number linked to Other Provider Identifier 1 (for example, a state Medicaid agency, Medicare, or a private insurance company).
Other Provider Identifier 4: 130590000
Field 41/88
An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 4: 01
Field 42/88
A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 4: IL
Field 43/88
The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier Issuer 4: US DEPT OF LABOR
Field 44/88
The name of the organization, agency, or health plan that assigned the additional provider identifier. This identifies who issued the number linked to Other Provider Identifier 1 (for example, a state Medicaid agency, Medicare, or a private insurance company).
Other Provider Identifier 5: 930124689
Field 45/88
An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 5: 01
Field 46/88
A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 5: IL
Field 47/88
The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier Issuer 5: RAILROAD MEDICARE
Field 48/88
The name of the organization, agency, or health plan that assigned the additional provider identifier. This identifies who issued the number linked to Other Provider Identifier 1 (for example, a state Medicaid agency, Medicare, or a private insurance company).
Other Provider Identifier 6: 0127
Field 49/88
An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 6: 01
Field 50/88
A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 6: IL
Field 51/88
The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier Issuer 6: BLUECROSS
Field 52/88
The name of the organization, agency, or health plan that assigned the additional provider identifier. This identifies who issued the number linked to Other Provider Identifier 1 (for example, a state Medicaid agency, Medicare, or a private insurance company).
Other Provider Identifier 7: =========
Field 53/88
An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 7: 01
Field 54/88
A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 7: IL
Field 55/88
The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier Issuer 7: FEIN
Field 56/88
The name of the organization, agency, or health plan that assigned the additional provider identifier. This identifies who issued the number linked to Other Provider Identifier 1 (for example, a state Medicaid agency, Medicare, or a private insurance company).
Other Provider Identifier 8: 5015121
Field 57/88
An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 8: 01
Field 58/88
A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 8: IL
Field 59/88
The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier Issuer 8: BLUESHIELD
Field 60/88
The name of the organization, agency, or health plan that assigned the additional provider identifier. This identifies who issued the number linked to Other Provider Identifier 1 (for example, a state Medicaid agency, Medicare, or a private insurance company).
Other Provider Identifier 9: P00034602
Field 61/88
An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 9: 01
Field 62/88
A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 9: IL
Field 63/88
The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier Issuer 9: RAILROAD MEDICARE
Field 64/88
The name of the organization, agency, or health plan that assigned the additional provider identifier. This identifies who issued the number linked to Other Provider Identifier 1 (for example, a state Medicaid agency, Medicare, or a private insurance company).
Other Provider Identifier 10: 060042510
Field 65/88
An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 10: 01
Field 66/88
A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 10: IL
Field 67/88
The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier Issuer 10: RAILROAD MEDICARE PARSONS
Field 68/88
The name of the organization, agency, or health plan that assigned the additional provider identifier. This identifies who issued the number linked to Other Provider Identifier 1 (for example, a state Medicaid agency, Medicare, or a private insurance company).
Other Provider Identifier 11: 110142202
Field 69/88
An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 11: 01
Field 70/88
A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 11: IL
Field 71/88
The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier Issuer 11: RAILROAD MEDICARE ZAFAR
Field 72/88
The name of the organization, agency, or health plan that assigned the additional provider identifier. This identifies who issued the number linked to Other Provider Identifier 1 (for example, a state Medicaid agency, Medicare, or a private insurance company).
Other Provider Identifier 12: 110237746
Field 73/88
An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 12: 01
Field 74/88
A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 12: IL
Field 75/88
The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier Issuer 12: RAILROAD MEDICARE PAL
Field 76/88
The name of the organization, agency, or health plan that assigned the additional provider identifier. This identifies who issued the number linked to Other Provider Identifier 1 (for example, a state Medicaid agency, Medicare, or a private insurance company).
Other Provider Identifier 13: =========401
Field 77/88
An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 13: 05
Field 78/88
A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 13: IL
Field 79/88
The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier 14: IL1789
Field 80/88
An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 14: 01
Field 81/88
A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 14: IL
Field 82/88
The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier Issuer 14: MEDICARE GROUP PTAN
Field 83/88
The name of the organization, agency, or health plan that assigned the additional provider identifier. This identifies who issued the number linked to Other Provider Identifier 1 (for example, a state Medicaid agency, Medicare, or a private insurance company).
Other Provider Identifier 15: P00034601
Field 84/88
An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 15: 01
Field 85/88
A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 15: IL
Field 86/88
The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier Issuer 15: RAILROAD MEDICARE
Field 87/88
The name of the organization, agency, or health plan that assigned the additional provider identifier. This identifies who issued the number linked to Other Provider Identifier 1 (for example, a state Medicaid agency, Medicare, or a private insurance company).
Is Organization Subpart: N
Field 88/88
Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.

Other Provider Identifiers 21

Legacy and payer-issued identifiers reported to the NPPES registry for this provider.

110142202 Other
Identifier 1/21
State: IL · Issuer: Railroad Medicare Zafar
Other: An additional provider identifier that does not correspond to any of the other defined identifier type categories.
060042510 Other
Identifier 2/21
State: IL · Issuer: Railroad Medicare Parsons
Other: An additional provider identifier that does not correspond to any of the other defined identifier type categories.
930124689 Other
Identifier 3/21
State: IL · Issuer: Railroad Medicare
Other: An additional provider identifier that does not correspond to any of the other defined identifier type categories.
825620 Medicare ID-Type Unspecified
Identifier 4/21
State: IL · Issuer: Wps Md Billing
Medicare ID (Type Unspecified): A Medicare-issued provider identifier whose specific subtype or program context has not been designated.
3573 Other
Identifier 5/21
State: IL · Issuer: Health Alliance Id
Other: An additional provider identifier that does not correspond to any of the other defined identifier type categories.
825610 Medicare ID-Type Unspecified
Identifier 6/21
Issuer: Ed Physician Billing
Medicare ID (Type Unspecified): A Medicare-issued provider identifier whose specific subtype or program context has not been designated.
IL1789004 Medicare PIN
Identifier 7/21
State: IL
Medicare PIN: Used in legacy data fields alongside a healthcare provider's National Provider Identifier (NPI) to designate legacy Medicare provider numbers.
130590000 Other
Identifier 8/21
State: IL · Issuer: Us Dept Of Labor
Other: An additional provider identifier that does not correspond to any of the other defined identifier type categories.
IL1789 Other
Identifier 9/21
State: IL · Issuer: Medicare Group Ptan
Other: An additional provider identifier that does not correspond to any of the other defined identifier type categories.
A6136401 Other
Identifier 10/21
State: IL · Issuer: United Healthcare River
Other: An additional provider identifier that does not correspond to any of the other defined identifier type categories.
5015121 Other
Identifier 11/21
State: IL · Issuer: Blueshield
Other: An additional provider identifier that does not correspond to any of the other defined identifier type categories.
110237746 Other
Identifier 12/21
State: IL · Issuer: Railroad Medicare Pal
Other: An additional provider identifier that does not correspond to any of the other defined identifier type categories.
215455 Medicare PIN
Identifier 13/21
State: IL
Medicare PIN: Used in legacy data fields alongside a healthcare provider's National Provider Identifier (NPI) to designate legacy Medicare provider numbers.
216265 Medicare PIN
Identifier 14/21
State: IL
Medicare PIN: Used in legacy data fields alongside a healthcare provider's National Provider Identifier (NPI) to designate legacy Medicare provider numbers.
202178 Medicare ID-Type Unspecified
Identifier 15/21
Issuer: Mnt Billing
Medicare ID (Type Unspecified): A Medicare-issued provider identifier whose specific subtype or program context has not been designated.
140026 Medicare ID-Type Unspecified
Identifier 16/21
Medicare ID (Type Unspecified): A Medicare-issued provider identifier whose specific subtype or program context has not been designated.
0127 Other
Identifier 17/21
State: IL · Issuer: Bluecross
Other: An additional provider identifier that does not correspond to any of the other defined identifier type categories.
P00034601 Other
Identifier 18/21
State: IL · Issuer: Railroad Medicare
Other: An additional provider identifier that does not correspond to any of the other defined identifier type categories.
=========001 Medicaid
Identifier 19/21
State: IL
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
=========401 Medicaid
Identifier 20/21
State: IL
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
P00034602 Other
Identifier 21/21
State: IL · Issuer: Railroad Medicare
Other: An additional provider identifier that does not correspond to any of the other defined identifier type categories.
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