Deaconess Illinois Specialty Clinic, Inc.
Organization Active NPI Orthopaedic Surgery Physician · Anna, IL
NPI 1134836612 · NPPES record last updated Jan 26, 2023
Key facts
- NPI
- 1134836612
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Orthopaedic Surgery Physician 207X00000X
- Legal business name
- DEACONESS ILLINOIS SPECIALTY CLINIC, INC.
- Practice address
- 513 N Main St
Anna, IL 62906-1668 - Phone
- (618) 998-7177
- Fax
- (618) 998-7742
- NPI assigned
- Nov 3, 2022
- Organization subpart
- No
Authorized official
- Name
- Kyle Dillman
- Title
- Secretary Treasurer
- Phone
- (812) 450-7399
Other NPIs on the same Medicare enrollment 23
Corporate family (same tax ID) 18
Practitioners 17
-
Kevin B Claffey, M.D.
-
Allison Anne Frost, FNP-C
-
Baqer A Haider, M.D.
-
Mustafa Hindi, M.D.
-
Tedra Ann Lawrence, APRN
-
Khalid Naseer, MD
-
Justin L Northcutt, PA-C
-
Ekanga Sunday Petters, M.D.
-
Megan Nicole Plummer, APRN
-
Sujatha Anasapurapu Rao, M.D.
-
Amar Rawal, MD
-
Amelia Kate Stigall, PA-C
-
Robert R Bell, MD
-
Charles T Dodson, DO
-
Meher S Mallick, M.D.
-
Eunice Ann Hai Huat Wong, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230321001688 | IL | Part B Supplier - Clinic/Group Practice | 9830562016 |
Receives reassigned benefits from 243 practitioners 23 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Marion, IL; West Frankfort, IL; Waterloo, IL; Salem, IL; Red Bud, IL; Mount Vernon, IL; Benton, IL; Harrisburg, IL… |
National Provider Directory
- Tax ID family
- Deaconess Illinois Specialty Clinic Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician |
207X00000X | Yes |
Addresses
Primary practice location
513 N Main St
Anna, IL 62906-1668
Mailing address
PO Box 34266
Belfast, ME 04915-0620
Phone (812) 450-6815
Other names
- Deaconess IL Specialty 513 N Main St
Other providers in Anna, IL
- Rebecca Compton
- Abigail Cowser-Barnett
- Crabtree and Merriman Dctrs of Optometry
- Deaconess Illinois Clinic, Inc
- Deaconess Illinois Clinic, Inc
- Deaconess Illinois Specialty Clinic, Inc.
- Deaconess Illinois Specialty Clinic, Inc.
- Deaconess Illinois Union County Hospital Inc
- Deaconess Illinois Union County Hospital Inc
- Deaconess Illinois Union County Hospital Inc
All providers in Anna, IL · Orthopaedic Surgery Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 26, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.