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PARK COURT PHARMACY
NPI 1790892818
Pharmacy - Community/Retail Pharmacy in Pekin, IL

Active since August 24, 2006
600 S 13TH ST, PEKIN, IL 61554(309) 347-9455(309) 347-1886 Get Directions Write a Review

NPPES record last updated: April 3, 2017. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Park Court Pharmacy NPPES

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

PARK COURT PHARMACY (NPI 1790892818) is a healthcare organization registered as a community/retail pharmacy in Pekin, Illinois and active in the NPI registry since August 2006. The organization lists Bob Haley, President, as its authorized official.

NPPES Registry Identity

NPI1790892818
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NamePEKIN PROHEALTH INC
Location Address600 S 13TH STPekin, IL 61554-4936
Mailing Address600 S 13th StPekin, IL 61554-4936 · (309) 347-9455 · Fax (309) 347-1886
Phone(309) 347-9455
Fax(309) 347-1886
Organization SubpartNo
Authorized OfficialBob HaleyPresident · (309) 347-1151
Enumeration DateAugust 24, 2006
Last NPPES UpdateApril 3, 2017
✔ NPI 1790892818 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers
Taxonomy Code3336C0003X
License✔ Licensed in IL · 054009001
Definition
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.
600 S 13TH ST, Pekin, IL 61554
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Other Names 1

Doing Business AsPark Court Pharmacy

Other Identifiers 3

Medicaid=========002IL
Other1453810IL · Ncpdp
Medicare NSC0428030004IL

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Park Court Pharmacy is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

142

Medicare enrollment records show 142 clinicians reassign Medicare billing to Park Court Pharmacy, which bills Medicare for the services they deliver. Of these, 5 practice at this address and 66 within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 21

Internal Medicine37
Nurse Practitioner25
Gastroenterology15
Hospitalist11
Family Practice10
General Surgery9
Cardiovascular Disease (Cardiology)7
Pediatric Medicine4
13 other specialties24

Nearest to this location (20)

See all 142
Farnaz Moazzam, M.D.
General Surgery
NPI 1487669735
600 S 13TH ST # I
Pekin, IL 61554
(309) 495-0200
✔ PECOS✔ Accepts MedicareSame address
Jana Huston, A.P.N.
Nurse Practitioner
NPI 1801345160
600 S 13TH ST SUITE E
Pekin, IL 61554
(309) 353-9709
✔ PECOS✔ Accepts MedicareSame address
Jonathan Rider, N.P.
Nurse Practitioner
NPI 1437526852
600 S 13TH ST SUITE E
Pekin, IL 61554
(309) 353-9709
✔ PECOS✔ Accepts MedicareSame address
Generoso Sison, M.D.
Family Practice
NPI 1609085273
600 S 13TH ST SUITE I
Pekin, IL 61554
(309) 346-1102
✔ PECOS✔ Accepts MedicareSame address
Michael Honan, M.D.
Internal Medicine
NPI 1255424750
600 S 13TH ST SUITE E
Pekin, IL 61554
(309) 353-0473
✔ PECOS✔ Accepts MedicareSame address
Kurt Glesne, D.P.M.
Podiatry
NPI 1346508280
2351 BROADWAY ST
Pekin, IL 61554
(309) 353-4159
✔ PECOS✔ Accepts Medicare1.2 mi
Jamaluddin Amanullah, M.D.
Hospitalist
NPI 1184673147
2401 BROADWAY ST LOWER LEVEL
Pekin, IL 61554
(314) 971-5717
✔ PECOS✔ Accepts Medicare1.4 mi
Janelle Fenski, APN
Nurse Practitioner
NPI 1790154532
19 OLT AVE
Pekin, IL 61554
(309) 353-6301
✔ PECOS1.8 mi
Richard Harvey, MD
Internal Medicine
NPI 1740259068
DEPT OF INTERNAL MEDICINE 530 NE GLEN OAK
Peoria, IL 61637
(309) 655-3292
✔ PECOS✔ Accepts Medicare5.3 mi
William Hicok, M.D.
Family Practice
NPI 1457326944
1506 W GARFIELD AVE
Bartonville, IL 61607
(309) 697-2416
✔ PECOS✔ Accepts Medicare6.1 mi
Mika Johnson, APRN-FPA
Nurse Practitioner
NPI 1063846467
123 S SAMPSON ST
Tremont, IL 61568
(309) 929-2030
✔ PECOS✔ Accepts Medicare7.9 mi
Jami Wallace, APRN
Nurse Practitioner
NPI 1144606195
711 W JOHN H GWYNN JR AVE
Peoria, IL 61605
(309) 680-7600
✔ PECOS✔ Accepts Medicare8.9 mi
Robin Alley, MD
General Surgery
NPI 1659689461
1001 MAIN ST STE 300
Peoria, IL 61606
(309) 495-0200
✔ PECOS✔ Accepts Medicare9.6 mi
Shiraz Khaiser, MD
Gastroenterology
NPI 1568681740
1001 MAIN ST SUITE 500A
Peoria, IL 61606
(309) 672-4980
✔ PECOS✔ Accepts Medicare9.6 mi
Jianming Dong, MD
Neurology
NPI 1619981305
900 MAIN ST SUITE 250
Peoria, IL 61602
(309) 672-4522
✔ PECOS9.6 mi
Shriram Lokare, M.D.
Rheumatology
NPI 1497057905
900 MAIN ST STE 600
Peoria, IL 61602
(309) 671-8270
✔ PECOS✔ Accepts Medicare9.6 mi
Justin Fischer, MD
Colorectal Surgery (Proctology)
NPI 1730456914
1001 MAIN ST STE 300
Peoria, IL 61606
(309) 495-0201
✔ PECOS✔ Accepts Medicare9.6 mi
Alexander Adler, MD
Cardiovascular Disease (Cardiology)
NPI 1912929118
112 NE CRESCENT 2ND FLOOR
Peoria, IL 61603
(309) 672-4670
✔ PECOS✔ Accepts Medicare9.7 mi
Anil Reddivari, M.D.,
Hospitalist
NPI 1164687968
221 NE GLEN OAK AVE
Peoria, IL 61636
(309) 672-5729
✔ PECOS✔ Accepts Medicare9.7 mi
Ibrahim Shamsi, DO
Pediatric Medicine
NPI 1710207105
530 NE GLEN OAK AVE
Peoria, IL 61637
(800) 599-7337
✔ PECOS9.9 mi
See all 142 clinicians

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

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 Pekin Prohealth Inc's NPI number?

The NPI number for Pekin Prohealth Inc is 1790892818. It was assigned to this organization in the NPPES registry on August 24, 2006. The provider is doing business as Park Court Pharmacy.

Where is Pekin Prohealth Inc located?

Pekin Prohealth Inc is located at 600 S 13th St, Pekin, IL 61554. The listed phone number is (309) 347-9455.

What is Pekin Prohealth Inc's specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Community/Retail Pharmacy, with taxonomy code 3336C0003X.

Is Pekin Prohealth Inc enrolled in Medicare?

Yes. Pekin Prohealth Inc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Pekin Prohealth Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 142 clinicians in 21 Medicare specialties reassign their Medicare billing to Pekin Prohealth Inc. 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. The largest specialties are Internal Medicine (37), Nurse Practitioner (25) and Gastroenterology (15). Of these, 5 practice at this address and 66 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Pekin Prohealth Inc was last updated on April 3, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.