Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1609892728 Individual Practitioner Male Practitioner

Dr. Chang Ki Song , MD

Surgery • Peoria, IL

Professional Overview & Biography Verified Profile Summary

Dr. Chang Song, MD is a registered healthcare professional specializing in Surgery in Peoria, IL. Practice services are available at 5401 N KNOXVILLE AVE under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

5401 N Knoxville Ave
Suite 217

Peoria, IL 616145098

Telephone 3096911092
Fax 3096896092
Associated Practice Facility / Clinic
🏢 Frank I Russo Facility NPI 1639140833

Specialty Benchmarks & Practice Insights

Comparative analytics for Surgery in Peoria, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 16.8 Yrs
State Avg: 27.3 Yrs
Regional Practice Density
37 Specialists

Practicing in Peoria, IL (1624 Statewide)

Telehealth Adoption Rate
10.8% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Surgery Primary Specialty

NUCC Taxonomy Code: 208600000X

State License IL 036060265

A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.

Surgery - Vascular Surgery

NUCC Taxonomy Code: 2086S0129X

State License IL 036060265

A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
036060265 (IL)
Commercial Insurance / Payer ID Blue Cross Blue Shield
07221997 (IL)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners
Dr. Yibing Li , MD

Physical Medicine & Rehabilitation

NPI 1013923929

Doctor of Medicine (M.D.)

Barbara Nall , APN

Nurse Practitioner - Women's Health

NPI 1053383471

Advanced Practice Nurse

Susan Gwillim , PT

Physical Therapist

NPI 1053410159

Physical Therapist

Dr. Kevin Henry , MD

Anesthesiology - Pain Medicine

NPI 1063490183

Doctor of Medicine (M.D.)

Colleen Cushing Ragon , APN, CNS

Nurse Practitioner - Family

NPI 1073804217

Advanced Practice Nurse, Clinical Nurse Specialist

Anne Waldrop , PT

Physical Therapist

NPI 1114026192

Physical Therapist

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active December 05, 2008

NPI status registered as active in NPPES database

📍
Updated Practice Location December 05, 2008

Registered at 5401 N KNOXVILLE AVE, SUITE 217, PEORIA, IL 616145098 (Tel: 3096911092)

📍
Updated Business Mailing Address December 05, 2008

Registered at 5401 N KNOXVILLE AVE, SUITE 209, PEORIA, IL 616145098 (Tel: 3096911092)

👤
Provider Name / Credentials Updated December 05, 2008

Recorded as CHANG SONG, MD

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) December 05, 2008

Surgery (License #036060265 in IL)

🟢
Initial NPI Registration & Enumeration July 14, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1609892728
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: July 14, 2006
Last Update: December 05, 2008
Sole Proprietor: Yes

Mailing Address

5401 N Knoxville Ave, Suite 209

Peoria, IL 616145098

Phone: 3096911092

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.