County of Lawrence Health Department
Organization Active NPI Hospice and Palliative Medicine (Family Medicine) Physician · Lawrenceville, IL
NPI 1073334835 · NPPES record last updated Oct 23, 2024
Key facts
- NPI
- 1073334835
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Hospice and Palliative Medicine (Family Medicine) Physician 207QH0002X
- Legal business name
- COUNTY OF LAWRENCE HEALTH DEPARTMENT
- Practice address
- 2101 James St
Lawrenceville, IL 62439-2027 - Phone
- (618) 943-3302
- NPI assigned
- Oct 23, 2024
- Organization subpart
- Yes
- Parent organization (as reported)
- COUNTY OF LAWRENCE HEALTH DEPARTMENT
Authorized official
- Name
- Tina Lyden
- Title
- Director of Patient Accounts
- Phone
- (618) 943-3302
Owned or controlled facilities with NPI records 1
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 7
Practitioners 9
-
Kelsey Dawn McCaslin, NP-C
-
Jeanne E. Holdren, APN
-
Gary D Carr, MD
-
Heather Ackman, MSN, APRN, PMHNP-BC
-
Emma Ray Engel, PMHNP
-
Amelia L Pauley, PMHNP
-
Yanci J Shroyer, PMHNP
-
Megan Williams, MSW, LCSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Lawrence County Health Department |
Rural health clinic | Operational/Managerial Control | Dec 1, 1997 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20241101001284 | IL | Part B Supplier - Clinic/Group Practice | 9830093723 |
Receives reassigned benefits from 1 practitioner Practice locations: Lawrenceville, IL |
National Provider Directory
- Tax ID family
- Cnty of Lawrence HLTH Dept
- Part of
- Cnty of Lawrence HLTH Dept
Locations
11020 State Route 250
Lawrenceville, IL 62439
Phone (618) 943-3754
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hospice and Palliative Medicine (Family Medicine) Physician |
207QH0002X | Yes |
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
- Lawrence County Health Department Palliative Care
Other providers in Lawrenceville, IL
- CHI National Home Care, LLC
- William Scott Childress
- Chittick Optical Inc
- Tiffany Clapp
- Community Alternatives Illinois, Inc.
- County of Lawrence Health Department
- County of Lawrence Health Department
- County of Lawrence Health Department
- County of Lawrence Health Department
- County of Lawrence Health Department
All providers in Lawrenceville, IL · Hospice and Palliative Medicine (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 Oct 23, 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.