{"npi":"1669540399","type":"NPI-2","status":"active","name":{"display":"Central Illinois Oral And Maxillofacial Surgery, PC","other":[],"organization_name":"CENTRAL ILLINOIS ORAL AND MAXILLOFACIAL SURGERY, PC","authorised_official":"Amy Kroeger"},"specialty":{"primary_taxonomy":"1223S0112X","primary_taxonomy_description":"Oral and Maxillofacial Surgery (Dentist)","slug":"oral-and-maxillofacial-surgery-dentist","schema_org_specialty":null,"all":[{"code":"1223S0112X","description":"Oral and Maxillofacial Surgery (Dentist)","primary":true,"state":null,"license":null}]},"addresses":[{"purpose":"LOCATION","street_1":"14 E ANTHONY DR","city":"CHAMPAIGN","state":"IL","postal_code":"618202748","country_code":"US","street_2":"SUITE C","phone":"2173552809","fax":"2173555921"},{"purpose":"MAILING","street_1":"14 E ANTHONY DR","city":"CHAMPAIGN","state":"IL","postal_code":"618202748","country_code":"US","street_2":"SUITE C","phone":"2173552809","fax":"2173555921"}],"license":null,"identifiers":[],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20070116000497","type_code":"12-70","type_desc":"PART B SUPPLIER - CLINIC/GROUP PRACTICE","state":"IL","pac_id":"4486655529"}]},"enumeration_date":"2006-12-01","last_updated":"2023-08-23","_meta":{"source":"NPPES","snapshot_date":"2023-08-23","doc_url":"https://findmynpi.com/api"}}