Active NPI
Carline Mekem Mbeumo, M.D.
- Pediatrics Physician
- Marion, IL
National Provider Identifier
1104268168
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 036140445
- Practice address
- 3412 Office Park Drive
Marion, IL 62959 - Phone
- (618) 993-0404
- Fax
- (618) 993-1717
- NPI assigned
- Jul 18, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 4301103909 | MI | |
| Pediatrics Physician | 208000000X | 036140445 | IL | Primary |
Addresses
Primary practice location
3412 Office Park Drive
Marion, IL 62959
Mailing address
3412 Office Park Drive
Marion, IL 62959
Phone (618) 993-0404
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036140445 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036140445 | IL | MD | Pediatrics Physician |
| 4301103909 | MI | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1374105600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478476800000",
"number": "1104268168",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3412 OFFICE PARK DRIVE",
"city": "MARION",
"state": "IL",
"postal_code": "62959",
"telephone_number": "618-993-0404",
"fax_number": "618-993-1717"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3412 OFFICE PARK DRIVE",
"city": "MARION",
"state": "IL",
"postal_code": "62959",
"telephone_number": "618-993-0404",
"fax_number": "618-993-1717"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MBEUMO",
"first_name": "CARLINE",
"middle_name": "MEKEM",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-07-18",
"last_updated": "2016-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MI",
"license": "4301103909",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IL",
"license": "036140445",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036140445",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Marion, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.