{"npi":"1699751289","type":"NPI-2","status":"active","name":{"display":"Eastland Medical Plaza Surgicenter, LLC","other":[],"organization_name":"EASTLAND MEDICAL PLAZA SURGICENTER, LLC","authorised_official":"Jackie Frye"},"specialty":{"primary_taxonomy":"261QA1903X","primary_taxonomy_description":"Ambulatory Surgical Clinic/Center","slug":"ambulatory-surgical-clinic-center","schema_org_specialty":null,"all":[{"code":"261QA1903X","description":"Ambulatory Surgical Clinic/Center","primary":true,"state":"IL","license":"7002413"}]},"addresses":[{"purpose":"LOCATION","street_1":"1505 EASTLAND DR","city":"BLOOMINGTON","state":"IL","postal_code":"617013534","country_code":"US","phone":"3096631997","fax":"3096629527"},{"purpose":"MAILING","street_1":"1505 EASTLAND DR","city":"BLOOMINGTON","state":"IL","postal_code":"617013534","country_code":"US","phone":"3096631997","fax":"3096629527"}],"license":{"state":"IL","number":"7002413"},"identifiers":[{"type_code":"01","label":"Other","value":"7002413","state":"IL","issuer":"STATE LICENSE"}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20100106000698","type_code":"12-49","type_desc":"PART B SUPPLIER - AMBULATORY SURGICAL CENTER","state":"IL","pac_id":"6406997956"}]},"enumeration_date":"2005-12-16","last_updated":"2010-01-06","_meta":{"source":"NPPES","snapshot_date":"2010-01-06","doc_url":"https://findmynpi.com/api"}}