NPIMap

Individual provider Active NPI

Eddie Lynn Paulk, D.O.

  • Internal Medicine Physician
  • Maryville, IL
National Provider Identifier
1003813601
Registry record updated Aug 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
R9H10 Issued in MO
Practice address
6812 State Route 162 Ste 21
Maryville, IL 62062-8565
Phone
(618) 288-5566
Fax
(618) 288-4005
NPI assigned
Jun 29, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 28, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X R9H10 MO Primary
General Practice Physician 208D00000X R9H10 MO

Addresses

Primary practice location

6812 State Route 162 Ste 21
Maryville, IL 62062-8565

Mailing address

6810 State Route 162 Box 215
Maryville, IL 62062-8501
Phone (618) 391-6405

Other identifiers 1

IdentifierTypeStateIssuer
242830743MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171129000036 IL Practitioner - Internal Medicine 4284618463 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anderson Medical Group LLCGroup PAC ID 5193792018, 136 clinicians

Practice addresses (Care Compare)

6812 State Route 162
Suite 204
Maryville, IL 62062-8562
Phone (618) 391-5070

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
74.76 of 100Reported as group
Quality
54.98
Promoting interoperability
85
Improvement activities
40
Cost
73.39

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
R9H10MOMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Anderson Medical Group, LLC Internal Medicine CurrentSince Dec 1, 2017 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
Lester E Cox Medical Centers Past Accepting new patients
Lester E Cox Medical Centers Internal Medicine Past Accepting new patients
Mercy Clinic East Communities Internal Medicine Past Accepting new patients
Ozarks Medical Center Past Accepting new patients
SSM St. Charles Clinic Medical Group, Inc. Internal Medicine Past Accepting new patients

Locations

1103 Belt Line Rd
#B
Collinsville, IL 62234
Phone (618) 344-0090

6812 State Route 162
Ste 204
Maryville, IL 62062
Phone (618) 288-6464

6810 State Route 162
Ste 215
Maryville, IL 62062
Phone (618) 391-6405

6812 State Route 162
Ste 21
Maryville, IL 62062
Phone (618) 228-8610

2090 Vadalabene Dr
Maryville, IL 62062
Phone (618) 288-5430

Networks

  • devoted network organization-1baeae7e-6b6f-49f9-a562-1b2d2e55c806
  • devoted network organization-734447cc-691b-4aa7-a112-9c9c8698dcc9
  • IL HMO C-SNP
  • IL PPO Downstate

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1120003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724803200000",
    "number": "1003813601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6810 STATE ROUTE 162 BOX 215",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620628501",
            "telephone_number": "618-391-6405",
            "fax_number": "618-288-4088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6812 STATE ROUTE 162 STE 21",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620628565",
            "telephone_number": "618-288-5566",
            "fax_number": "618-288-4005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAULK",
        "first_name": "EDDIE",
        "middle_name": "LYNN",
        "name_prefix": "Mr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-29",
        "last_updated": "2024-08-28",
        "certification_date": "2024-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "R9H10",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MO",
            "license": "R9H10",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "242830743",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maryville, IL

Sources for this page

Verify at the official NPI Registry.