Glen Avenue Family Practice – General Practice Physician, NPI 1689896961

Glen Avenue Family Practice is a healthcare provider. based in Peoria, Illinois. specializing in General Practice Physician. The organization holds a License No. 036067626 (IL). The NPI Number for Glen Avenue Family Practice is 1689896961

Main info

Organization
Name
Glen Avenue Family Practice
NPI
1689896961
Phone
(309) 692-7575
Address
4930 N EXECUTIVE DR
Authorized Official
SUSAN LAFOLLETTE BILLING MANAGER
Enumeration Date
3 May 2007
Last Update Date
30 June 2008
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience52
Completeness80
Years active:19State licenses:1Digital endpointsUpdated within 12 months

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Provider Addresses for Glen Avenue Family Practice

  • North Executive Drive, Peoria, Peoria County, Illinois, 61614, United States

    PEORIA, IL 616144894

    Phone: (309) 692-7575

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 61614)

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Reviews

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Frequently asked questions

What is the registry number for Glen Avenue Family Practice?
The registry entry for Glen Avenue Family Practice shows NPI 1689896961.
Should I treat Glen Avenue Family Practice as an active provider?
Patients and plans typically see Glen Avenue Family Practice as active in the national extract.
What does the directory say Glen Avenue Family Practice does?
Insurance directories may phrase it differently, but here Glen Avenue Family Practice maps to General Practice Physician. Clinical services aligned with this taxonomy classification.
What city is tied to Glen Avenue Family Practice?
The directory associates Glen Avenue Family Practice with Peoria, Illinois. Check all listed addresses for suites or satellite offices.
Who maintains Glen Avenue Family Practice's record?
Providers certify NPPES data; CMS hosts the public file you are viewing.

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