NPIMap

Organization Active NPI

Generation Clinical Partners Aco, LLC

Doing business as GCP ACO Illinois

  • Internal Medicine Physician
  • Waterloo, IL
National Provider Identifier
1104674431
Registry record updated May 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
GENERATION CLINICAL PARTNERS ACO, LLC
Doing business as
GCP ACO Illinois
Practice address
623 Hamacher St
Waterloo, IL 62298-1786
Phone
(314) 925-0903
NPI assigned
May 10, 2024
Last updated
May 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2024

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

Authorized official

Name
Rebecca Mueller
Title
Office Manager
Phone
(314) 925-0903

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

623 Hamacher St
Waterloo, IL 62298-1786

Mailing address

10426 Baur Blvd
Saint Louis, MO 63132-1905
Phone (314) 925-0903

Other practice location 1

726 Community Dr # D
Belleville, IL 62223-1026
Phone (314) 925-0903

Other names 1

  • GCP ACO Illinois Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 20

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.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1715299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715299200000",
    "number": "1104674431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10426 BAUR BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631321905",
            "telephone_number": "314-925-0903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "623 HAMACHER ST",
            "city": "WATERLOO",
            "state": "IL",
            "postal_code": "622981786",
            "telephone_number": "314-925-0903"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "726 Community Dr # D",
            "address_purpose": "LOCATION",
            "city": "Belleville",
            "state": "IL",
            "postal_code": "622231026",
            "country_code": "US",
            "telephone_number": "314-925-0903",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GENERATION CLINICAL PARTNERS ACO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-10",
        "last_updated": "2024-05-10",
        "certification_date": "2024-05-10",
        "status": "A",
        "authorized_official_last_name": "MUELLER",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "314-925-0903"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GCP ACO Illinois",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waterloo, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2024; 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.