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GLEN AVENUE FAMILY PRACTICE
NPI 1689896961
General Practice in Peoria, IL

Active since May 03, 2007
4930 N EXECUTIVE DR, PEORIA, IL 61614(309) 692-7575 Get Directions Write a Review

NPPES record last updated: June 30, 2008. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Glen Avenue Family Practice NPPES

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

GLEN AVENUE FAMILY PRACTICE (NPI 1689896961) is a healthcare organization registered as a general practice in Peoria, Illinois and active in the NPI registry since May 2007. The organization lists Susan Lafollette, Billing Manager, as its authorized official.

NPPES Registry Identity

NPI1689896961
Entity TypeOrganization
Primary Taxonomy208D00000X
Legal Business NameSYED MASOOD ALI, MDSC
Location Address4930 N EXECUTIVE DRPeoria, IL 61614-4894
Mailing Address4930 N Executive DrPeoria, IL 61614-4894 · (309) 692-7575
Phone(309) 692-7575
Organization SubpartNo
Authorized OfficialSusan LafolletteBilling Manager · (309) 671-8749
Enumeration DateMay 3, 2007
Last NPPES UpdateJune 30, 2008
✔ NPI 1689896961 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
License✔ Licensed in IL · 036067626
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
4930 N EXECUTIVE DR, Peoria, IL 61614
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Other Names 1

Doing Business AsGlen Avenue Family Practice

Other Identifiers 3

Medicare ID-Type Unspecified769552IL
Other212719IL · Medicare Group Id
Medicare UPINE10696IL

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

Other Providers at the Same Location NPPES 4

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

PEORIA INTEGRATIVE MEDICAL CENTER LTD
Family Medicine
4930 N EXECUTIVE DR, SUITE B
PEORIA, IL 61614
Peoria County (309) 683-6002
DR. SYED MASOOD ALI M.D.
Family Medicine
4930 N EXECUTIVE DR
PEORIA, IL 61614
Peoria County (309) 691-3707
MAQBOOL B ALI M.D
Surgery
4930 N EXECUTIVE DR
PEORIA, IL 61614
Peoria County (309) 692-7575
GREATER PEORIA OBSTETRICS & GYNECOLOGY CORP SC
Specialist
4930 N EXECUTIVE DR
PEORIA, IL 61614
Peoria County (309) 671-8749

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 Syed Masood Ali, Mdsc's NPI number?

The NPI number for Syed Masood Ali, Mdsc is 1689896961. It was assigned to this organization in the NPPES registry on May 3, 2007. The provider is doing business as Glen Avenue Family Practice.

Where is Syed Masood Ali, Mdsc located?

Syed Masood Ali, Mdsc is located at 4930 N Executive Dr, Peoria, IL 61614. The listed phone number is (309) 692-7575.

What is Syed Masood Ali, Mdsc's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

When was this NPI record last updated?

The NPPES record for Syed Masood Ali, Mdsc was last updated on June 30, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.