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MED PEDS ASSOCIATES
NPI 1649353970
Non-Pharmacy Dispensing Site in Kankakee, IL

Active since October 23, 2006
375 N WALL ST STE P520, KANKAKEE, IL 60901(815) 933-0194(815) 933-1444 Get Directions Write a Review

NPPES record last updated: September 3, 2008. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Med Peds Associates NPPES

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

MED PEDS ASSOCIATES (NPI 1649353970) is a healthcare organization registered as a non-pharmacy dispensing site in Kankakee, Illinois and active in the NPI registry since October 2006. The organization lists Direndia Shackelford, Managed Care Specialist, as its authorized official.

NPPES Registry Identity

NPI1649353970
Entity TypeOrganization
Primary Taxonomy332900000X
Legal Business NameMED PEDS ASSOCIATES
Location Address375 N WALL ST STE P520Kankakee, IL 60901-3493
Mailing Address375 N Wall St Ste P520Kankakee, IL 60901-3493
Phone(815) 933-0194
Fax(815) 933-1444
Organization SubpartNo
Authorized OfficialDirendia ShackelfordManaged Care Specialist · (800) 654-0889
Enumeration DateOctober 23, 2006
Last NPPES UpdateSeptember 3, 2008
✔ NPI 1649353970 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNon-Pharmacy Dispensing SiteSuppliers
Taxonomy Code332900000X
License✔ Licensed in IL · 036074737
Definition
A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)
375 N WALL ST STE P520, Kankakee, IL 60901
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Other Names 1

Doing Business AsMed Peds Associates

Other Identifiers 2

Medicaid036074737IL
Other1472505Other Id Number-commercial Number

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. ALYCE F JACKSON MD
Physical Medicine & Rehabilitation
375 N WALL ST STE P520
KANKAKEE, IL 60901
Kankakee County (815) 932-6632
DR. EKUA BAIDUA GILBERT-BAFFOE MD
Physical Medicine & Rehabilitation
375 N WALL ST STE P520
KANKAKEE, IL 60901
Kankakee County (815) 932-6632
MRS. MARISSA NICOLE RUEBHAUSEN NP-C
Nurse Practitioner (Family)
375 N WALL ST STE P520
KANKAKEE, IL 60901
Kankakee County (815) 932-6632

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 Med Peds Associates's NPI number?

The NPI number for Med Peds Associates is 1649353970. It was assigned to this organization in the NPPES registry on October 23, 2006.

Where is Med Peds Associates located?

Med Peds Associates is located at 375 N Wall St Ste P520, Kankakee, IL 60901. The listed phone number is (815) 933-0194.

What is Med Peds Associates's specialty?

The primary specialty registered for this NPI is Non-Pharmacy Dispensing Site with taxonomy code 332900000X.

When was this NPI record last updated?

The NPPES record for Med Peds Associates was last updated on September 3, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 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.