NPIMap

Organization Active NPI

Mercy Clinic Surgical Specialists-Illinois LLC

  • Surgery Physician
  • Maryville, IL
National Provider Identifier
1043713886
Registry record updated Apr 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
MERCY CLINIC SURGICAL SPECIALISTS-ILLINOIS LLC
Practice address
2227 Vadalabene Dr Ste 200
Maryville, IL 62062-5824
Phone
(618) 288-2052
NPI assigned
Mar 16, 2018
Last updated
Apr 28, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
MERCY CLINIC EAST COMMUNITIESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 28, 2025

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

Authorized official

Name
Kerry Dunger
Title
Executive Director - Finance
Phone
(314) 364-3707

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X NU Primary

Addresses

Primary practice location

2227 Vadalabene Dr Ste 200
Maryville, IL 62062-5824

Mailing address

2227 Vadalabene Dr Ste 200
Maryville, IL 62062-5824
Phone (618) 288-2052

Other practice location 1

6812 State Route 162 Ste 121
Maryville, IL 62062-8586
Phone (314) 543-5999

Other identifiers 1

IdentifierTypeStateIssuer
500052754MedicaidMO

National Provider Directory

National Provider Directory
Part of
Mercy Clinic Communities

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

6812 State Route 162
Ste 121
Maryville, IL 62062
Phone (314) 543-5999

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1521158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745798400000",
    "number": "1043713886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2227 VADALABENE DR STE 200",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620625824",
            "telephone_number": "618-288-2052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2227 VADALABENE DR STE 200",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620625824",
            "telephone_number": "618-288-2052"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6812 State Route 162 Ste 121",
            "address_purpose": "LOCATION",
            "city": "Maryville",
            "state": "IL",
            "postal_code": "620628586",
            "country_code": "US",
            "telephone_number": "314-543-5999",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MERCY CLINIC SURGICAL SPECIALISTS-ILLINOIS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MERCY CLINIC EAST COMMUNITIES",
        "enumeration_date": "2018-03-16",
        "last_updated": "2025-04-28",
        "certification_date": "2025-04-28",
        "status": "A",
        "authorized_official_last_name": "DUNGER",
        "authorized_official_first_name": "KERRY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR - FINANCE",
        "authorized_official_telephone_number": "314-364-3707"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500052754",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maryville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.