Physical Medicine Clinic of Granite City LTD

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

Legal business name

PHYSICAL MEDICINE CLINIC OF GRANITE CITY LTD

Practice address

2861 Madison Ave
Granite City, IL 62040-3614

Phone

(618) 877-4000

NPI assigned

Jan 31, 2012

Organization subpart

Yes

Parent organization

PHYSICAL MEDICINE CLINIC OF GRANITE CITY LTDAs reported in NPPES

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

Authorized official

Name

Dr. Bud Chombirun, M.D.

Title

Medical Director

Phone

(618) 877-4000

Specialties & licenses 1

Addresses

Part of

Physical Medicine Clinic of

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Physical Medicine Clinic of Granite City LTD

  • Adult Health Nurse Practitioner
  • Granite City, IL
  • NPI 1992039747
  NPPES parent name

Practitioners 1

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

• Bridget Ellen Brasfield, DC DR OF CHIRO MED

  • Chiropractor
  • Granite City, IL
  • NPI 1205948577
  NPD (past)

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

{
    "created_epoch": "1327968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327968000000",
    "number": "1083986541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2980 N BEVERLY GLEN CIR",
            "address_2": "SUITE 301",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900771726",
            "telephone_number": "310-474-9809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2861 MADISON AVE",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620403614",
            "telephone_number": "618-877-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL MEDICINE CLINIC OF GRANITE CITY LTD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PHYSICAL MEDICINE CLINIC OF GRANITE CITY LTD",
        "enumeration_date": "2012-01-31",
        "last_updated": "2012-01-31",
        "status": "A",
        "authorized_official_last_name": "CHOMBIRUN",
        "authorized_official_first_name": "BUD",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "618-877-4000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joellyn Marie Patterson, BA, CADC
• Janice M Pautler, RD,LD
• Albert Pelate, RPH
• Oscar Adrian Perez, PA-C
• Phillips Chiropractic LLC
• Physical Medicine Clinic of Granite City LTD
• Victor Manuel Pinones, D.M.D
• Adriana Poenitzsch, RPH
• Heather Roan Porter, PTA
• Donna Kay Porterfield, D.M.D.

• Non-Pharmacy Dispensing Site in Granite City, IL
• Providers in Granite City, IL by specialty
• Non-Pharmacy Dispensing Site in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2012; 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.