EDMUND THOMAS PEACOCK MD
NPI 1356239776
Student in an Organized Health Care Education/Training Program in Chicago, IL
About Edmund Thomas Peacock Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
EDMUND THOMAS PEACOCK MD (NPI 1356239776) is an individual student in an organized health care education/training program in Chicago, Illinois, licensed in Illinois (125.086315) and active in the NPI registry since June 2025. He is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses 2
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Edmund Thomas Peacock Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Other Providers at the Same Location NPPES 18
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
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 Edmund Peacock's NPI number?
The NPI number for Edmund Peacock is 1356239776. It was assigned to this individual provider in the NPPES registry on June 25, 2025.
Where is Edmund Peacock located?
Edmund Peacock practices at 1750 W Harrison St Ste 108, Chicago, IL 60612. The listed phone number is (312) 942-7802.
What is Edmund Peacock's specialty?
The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.
Is Edmund Peacock enrolled in Medicare?
Yes. Edmund Peacock is registered in the Medicare PECOS enrollment system.
When was this NPI record last updated?
The NPPES record for Edmund Peacock was last updated on August 5, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months 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.
# Edmund Thomas Peacock, MD · NPI 1356239776
Student in an Organized Health Care Education/Training Program provider in Chicago, Illinois. Individual provider, active in the CMS NPPES registry since June 25, 2025.
## Identity
- **NPI:** 1356239776 (Entity type: Individual)
- **Enumerated:** June 25, 2025
- **Primary specialty:** Student in an Organized Health Care Education/Training Program · taxonomy 390200000X
- **State license:** 125.086315 (Illinois)
- **Sole proprietor:** No
## Practice location
- **Address:** 1750 W HARRISON ST STE 108, Chicago, IL 60612-3825
- **Phone:** (312) 942-7802
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
## Record status
- **NPPES last updated:** August 5, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1356239776) · Data from the CMS NPPES public registry.