George Brummell, PMHNP-BC
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Carthage, IL
NPI 1114693181 · NPPES record last updated Jul 3, 2023
Key facts
- NPI
- 1114693181
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 209026348 (IL)
- Practice address
- 1450 N County Road 2050 E
Carthage, IL 62321-3551 - Phone
- (217) 357-6888
- NPI assigned
- Aug 19, 2021
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 10
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Memorial Hospital Association
Practice addresses (Care Compare)
1454 N Co Rd 2050
Carthage, IL 62321-0160
1454 N County Rd
Carthage, IL 62321-0160
Phone (217) 357-8500
PO Box
Carthage, IL 62321-0160
Hospital & facility affiliations
- Memorial Hospital
- MC Donough District Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230309000726 | IL | Practitioner - Nurse Practitioner | 3971909540 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP61194142 | WA | MD | Adult Psychiatric/Mental Health Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Luke'S Methodist Hospital | Current | Accepting new patients | |
| Memorial Hospital Association | Current |
Accepting new patients | |
| Memorial Hospital Association | Current | Accepting new patients | |
| Memorial Hospital Association | Current |
Accepting new patients | |
| Memorial Hospital Association | Past | Accepting new patients | |
| Memorial Hospital Association | Past | Accepting new patients | |
| Memorial Hospital Association | Past | Accepting new patients |
Locations
209 E 5th St
Bowen, IL 62316
Phone (217) 842-5211
1450 N County Road 2050 E
Carthage, IL 62321
Phone (217) 357-2173
630 Locust St
Ste A
Carthage, IL 62321
1454 N County Road 2050 E
Carthage, IL 62321
Phone (217) 357-3131
630 Locust St
Carthage, IL 62321
Phone (217) 357-2173
1471 Keokuk St
Hamilton, IL 62341
Phone (217) 847-3383
951 Broadway St
Hamilton, IL 62341
Phone (217) 551-3100
501 E Main St
La Harpe, IL 61450
Phone (217) 659-3844
Interoperability endpoints
- gbrummell932803@direct.unitypoint.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Psychiatric/Mental Health Registered Nurse | 163WP0809X | AP61194142 | WA | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 209026348 | IL | Yes |
Addresses
Primary practice location
1450 N County Road 2050 E
Carthage, IL 62321-3551
Mailing address
1450 N County Road 2050 E
Carthage, IL 62321-3551
Phone (217) 357-6888
Other providers in Carthage, IL
- Tracey Lynn-Severt Behymer
- Stephen K Bergman
- Curtis Bisby
- Melissa K Brewer
- Rodney Brumley
- Lindsay Brummell
- Douglas C Buelt
- Rosalinda Campos
- Krista M Carle
- Philip Ralph Caropreso
All providers in Carthage, IL · Psychiatric/Mental Health Nurse Practitioner in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 3, 2023. 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.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.