Heartland Pediatric Clinic

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

HEARTLAND PEDIATRIC CLINIC

Practice address

1000 W Deyoung St
Marion, IL 62959-1630

Phone

(618) 993-5274

Fax

(618) 999-0639

NPI assigned

Sep 2, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Luis Alberto Lopez, M.D.

Title

President/Physician

Phone

(618) 993-5274

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Rural health clinic certification: CCN 148966

Legal name

HEARTLAND PEDIATRIC CLINIC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Oct 29, 2004

Last certification

Jun 5, 2024

Ownership / control type

1B

Most recent change of ownership

Mar 1, 2010 (1 total)

Organization structure

CorporationProprietary

Incorporated

Mar 10, 2010 in IL

Enrollment address

1000 W Deyoung St
Marion, IL 62959-1630

Locations

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gina Gladson, MSN FNP-C

  • Nurse Practitioner
  • Marion, IL
  • NPI 1437699147
  NPD (past)

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

{
    "created_epoch": "1157155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598918400000",
    "number": "1053413740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1866",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629598066",
            "telephone_number": "618-993-5274",
            "fax_number": "618-993-0639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 W DEYOUNG ST",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629591630",
            "telephone_number": "618-993-5274",
            "fax_number": "618-999-0639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEARTLAND PEDIATRIC CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-02",
        "last_updated": "2020-09-01",
        "certification_date": "2020-09-01",
        "status": "A",
        "authorized_official_last_name": "LOPEZ",
        "authorized_official_first_name": "LUIS",
        "authorized_official_middle_name": "ALBERTO",
        "authorized_official_title_or_position": "PRESIDENT/PHYSICIAN",
        "authorized_official_telephone_number": "618-993-5274",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Lynn Hazel
• Health Heroes of Illinois, Inc.
• Health Plan of Southern Illinois, Inc.
• Healthdirect Institutional Pharmacy Services, Inc.
• Heartland Balance and Hearing Center SC
• Heartland Rural Healthcare, LLC
• Heartland Rural Healthcare, LLC
• Heartland Spine, LLC
• Heartland Surgery LLC
• Heartland Women'S Healthcare LTD

• Rural Health Clinic/Center in Marion, IL
• Providers in Marion, IL by specialty
• Rural Health Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.