NPIMap

Organization Active NPI

Deaconess Specialty Physicians, Inc

  • Cardiovascular Disease Physician
  • Fairfield, IL
National Provider Identifier
1003317785
Registry record updated May 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
DEACONESS SPECIALTY PHYSICIANS, INC
Practice address
213 NW 10TH St
Fairfield, IL 62837
Phone
(812) 450-7899
Fax
(812) 450-6029
NPI assigned
Feb 27, 2018
Last updated
May 15, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Cheryl A Wathen
Title
Secretary/Treasurer
Phone
(812) 450-3296

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X Primary
Clinical Cardiac Electrophysiology Physician 207RC0001X
Interventional Cardiology Physician 207RI0011X

Addresses

Primary practice location

213 NW 10TH St
Fairfield, IL 62837

Mailing address

PO Box 1230
Evansville, IN 47706-1230
Phone (812) 450-7899

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180523001150 IL Part B Supplier - Clinic/Group Practice 0244595205 Receives reassigned benefits from 16 practitioners
9 other NPIs on this enrollment
Practice locations: Carmi, IL; Olney, IL; Mount Carmel, IL; MC Leansboro, IL; Fairfield, IL; Eldorado, IL

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Deaconess Specialty Physicians Inc45 organizations share this tax ID, including this one

Other organizations with this tax ID 44

Organizations that report the same tax identification number in the National Provider Directory.

View all 44

Locations

1306 Maple St
Eldorado, IL 62930
Phone (618) 273-2360

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1519689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526342400000",
    "number": "1003317785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1230",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477061230",
            "telephone_number": "812-450-7899",
            "fax_number": "812-450-6029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 NW 10TH ST",
            "city": "FAIRFIELD",
            "state": "IL",
            "postal_code": "62837",
            "telephone_number": "812-450-7899",
            "fax_number": "812-450-6029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEACONESS SPECIALTY PHYSICIANS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-27",
        "last_updated": "2018-05-15",
        "status": "A",
        "authorized_official_last_name": "WATHEN",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "SECRETARY/TREASURER",
        "authorized_official_telephone_number": "812-450-3296"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.