NPIMap

Organization Active NPI

St .Clair Pedaitrics, LLC

  • Pediatrics Physician
  • Swansea, IL
National Provider Identifier
1073705737
Registry record updated Aug 15, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
ST .CLAIR PEDAITRICS, LLC
Practice address
4941 Benchmark Centre Dr
Suite 100
Swansea, IL 62226-2038
Phone
(618) 624-9970
Fax
(618) 624-9973
NPI assigned
Aug 15, 2007
Last updated
Aug 15, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2007

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

Authorized official

Name
Dr. Gregory T Garrison, M.D.NPI 1003920950
Title
Owner
Phone
(618) 624-9970

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X IL Primary

Addresses

Primary practice location

4941 Benchmark Centre Dr
Suite 100
Swansea, IL 62226-2038

Mailing address

4941 Benchmark Centre Dr
Suite 100
Swansea, IL 62226-2038
Phone (618) 624-9970

Other identifiers 1

IdentifierTypeStateIssuer
08223014OtherILBLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory

Locations

4941 Benchmark Centre Dr
Ste 100
Swansea, IL 62226
Phone (618) 624-9970

Practitioners & affiliated clinicians

Practitioners 10

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": "1187136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187136000000",
    "number": "1073705737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4941 BENCHMARK CENTRE DR",
            "address_2": "SUITE 100",
            "city": "SWANSEA",
            "state": "IL",
            "postal_code": "622262038",
            "telephone_number": "618-624-9970",
            "fax_number": "618-624-9973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4941 BENCHMARK CENTRE DR",
            "address_2": "SUITE 100",
            "city": "SWANSEA",
            "state": "IL",
            "postal_code": "622262038",
            "telephone_number": "618-624-9970",
            "fax_number": "618-624-9973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST .CLAIR PEDAITRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-15",
        "last_updated": "2007-08-15",
        "status": "A",
        "authorized_official_last_name": "GARRISON",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-624-9970",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "08223014",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Swansea, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2007; 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.