NPIMap

Individual provider Active NPI

Brandon Cycholl

  • Family Medicine Physician
  • Flora, IL
National Provider Identifier
1144208349
Registry record updated May 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036107332 Issued in IL
Practice address
929 Stacey Burk Dr
Clay County Hospital Medical Clinic
Flora, IL 62839-3241
Phone
(618) 662-2131
Fax
(618) 662-3077
NPI assigned
Jan 6, 2006
Last updated
May 6, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036107332 IL Primary

Addresses

Primary practice location

929 Stacey Burk Dr
Clay County Hospital Medical Clinic
Flora, IL 62839-3241

Mailing address

929 Stacey Burk Dr
Clay County Hospital Medical Clinic
Flora, IL 62839-3241
Phone (618) 662-2131

Other identifiers 3

IdentifierTypeStateIssuer
036107332MedicaidIL
482023OtherHEALTHLINK
086757OtherHEALTH ALLIANCE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150923000906 IL Practitioner - Family Practice 7911074448 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
County of ClayGroup PAC ID 0042101982, shared by 6 NPIs, 77 clinicians

Practice addresses (Care Compare)

911 Stacey Burk Dr
Flora, IL 62839-3241
Phone (618) 662-2131

929 Stacey Burk Dr
Flora, IL 62839-3241
Phone (618) 662-2131

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
County of Clay Current Accepting new patients
County of Clay CurrentSince Jun 18, 2018 Accepting new patients
County of Clay CurrentSince Jun 18, 2018 Accepting new patients
County of Clay Past Accepting new patients

Locations

911 Stacey Burk Dr
Flora, IL 62839
Phone (618) 662-2161

929 Stacey Burk Dr
Flora, IL 62839

Interoperability endpoints

  • Direct secure messaging: bcych@yourcarecommunity.org
  • Direct secure messaging: bcycholl370690@direct-ehr-ssmhc.com

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Clay Home Health ServicesFlora, IL, CCN 147086 Home health agency Operational/Managerial Control Dec 1, 2015
Clay County Health Department HospiceFlora, IL, CCN 141611 Hospice Corporate Director Dec 1, 2015

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1136505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462492800000",
    "number": "1144208349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "929 STACEY BURK DR",
            "address_2": "CLAY COUNTY HOSPITAL MEDICAL CLINIC",
            "city": "FLORA",
            "state": "IL",
            "postal_code": "628393241",
            "telephone_number": "618-662-2131",
            "fax_number": "618-662-3077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "929 STACEY BURK DR",
            "address_2": "CLAY COUNTY HOSPITAL MEDICAL CLINIC",
            "city": "FLORA",
            "state": "IL",
            "postal_code": "628393241",
            "telephone_number": "618-662-2131",
            "fax_number": "618-662-3077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CYCHOLL",
        "first_name": "BRANDON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-06",
        "last_updated": "2016-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036107332",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036107332",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "482023",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "086757",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Flora, IL

Sources for this page

Verify at the official NPI Registry.