NPIMap

Organization Active NPI

County of Lawrence Health Department

Doing business as Lawrence County Health Department Palliative Care

  • Hospice and Palliative Medicine (Family Medicine) Physician
  • Lawrenceville, IL
National Provider Identifier
1073334835
Registry record updated Oct 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospice and Palliative Medicine (Family Medicine) PhysicianTaxonomy code 207QH0002X
Legal business name
COUNTY OF LAWRENCE HEALTH DEPARTMENT
Doing business as
Lawrence County Health Department Palliative Care
Practice address
2101 James St
Lawrenceville, IL 62439-2027
Phone
(618) 943-3302
NPI assigned
Oct 23, 2024
Last updated
Oct 23, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
COUNTY OF LAWRENCE HEALTH DEPARTMENTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 23, 2024

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

Authorized official

Name
Tina Lyden
Title
Director of Patient Accounts
Phone
(618) 943-3302

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospice and Palliative Medicine (Family Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207QH0002X Primary

Addresses

Primary practice location

2101 James St
Lawrenceville, IL 62439-2027

Mailing address

2101 James St
Lawrenceville, IL 62439-2027
Phone (618) 943-3302

Other names 1

  • Lawrence County Health Department Palliative Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241101001284 IL Part B Supplier - Clinic/Group Practice 9830093723 Receives reassigned benefits from 1 practitioner
Practice locations: Lawrenceville, IL

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Co of Lawrence Health Dept8 organizations share this tax ID, including this one
Part of
Co of Lawrence Health Dept

Other organizations with this tax ID 7

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

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Lawrence County Health DepartmentLawrenceville, IL, CCN 143951 Rural health clinic Operational/Managerial Control Dec 1, 1997

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1729641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729641600000",
    "number": "1073334835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 JAMES ST",
            "city": "LAWRENCEVILLE",
            "state": "IL",
            "postal_code": "624392027",
            "telephone_number": "618-943-3302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 JAMES ST",
            "city": "LAWRENCEVILLE",
            "state": "IL",
            "postal_code": "624392027",
            "telephone_number": "618-943-3302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF LAWRENCE HEALTH DEPARTMENT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COUNTY OF LAWRENCE HEALTH DEPARTMENT",
        "enumeration_date": "2024-10-23",
        "last_updated": "2024-10-23",
        "certification_date": "2024-10-23",
        "status": "A",
        "authorized_official_last_name": "LYDEN",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "DIRECTOR OF PATIENT ACCOUNTS",
        "authorized_official_telephone_number": "618-943-3302"
    },
    "taxonomies": [
        {
            "code": "207QH0002X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lawrence County Health Department Palliative Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lawrenceville, IL

Sources for this page

Verify at the official NPI Registry.