Saint Anthony Medical Center
Organization Active NPI Family Medicine Physician · Marengo, IL
NPI 1003869967 · NPPES record last updated Mar 7, 2024
Key facts
- NPI
- 1003869967
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- SAINT ANTHONY MEDICAL CENTER
- Practice address
- 556 E Grant Hwy
Marengo, IL 60152-3346 - Phone
- (800) 589-6070
- Fax
- (309) 683-5969
- NPI assigned
- May 19, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- OSF HEALTHCARE SYSTEM
Authorized official
- Name
- Robert C Sehring
- Title
- Ceo
- Phone
- (309) 655-2850
Other NPIs on the same Medicare enrollment 16
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040102000555 | IL | Part B Supplier - Clinic/Group Practice | 5496654006 |
Receives reassigned benefits from 73 practitioners 16 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Loves Park, IL; Mendota, IL; Rochelle, IL; Rockford, IL |
National Provider Directory
- Part of
- Eastland Med Plaza Surg
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/JICDAD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Internal Medicine Physician |
207R00000X | |||
| Pediatrics Physician |
208000000X |
Addresses
Primary practice location
556 E Grant Hwy
Marengo, IL 60152-3346
Mailing address
124 SW Adams St
Peoria, IL 61602-1308
Phone (309) 655-2850
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10123444 | Other | IL | BLUE CROSS |
Other names
- OSFMG - Marengo Clinic
Other providers in Marengo, IL
- Quality Renal Care LLC
- Erin Michelle Randall
- Riley Community Cons School Dist #18
- Javier Ramiro Rodriguez
- Jon W Russell
- Janelle Jean Schultz
- Janet Schultz
- Elizabeth E Siegfort
- Manfred Strohschein
- Swedishamerican Hospital
All providers in Marengo, IL · Family Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.