NPIMap

Organization Active NPI

Deaconess Illinois Specialty Clinic, Inc.

Doing business as Deaconess IL Specialty Clinic Occupational Health

  • Nurse Practitioner
  • Marion, IL
National Provider Identifier
1154036259
Registry record updated Jan 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
DEACONESS ILLINOIS SPECIALTY CLINIC, INC.
Doing business as
Deaconess IL Specialty Clinic Occupational Health
Practice address
3331 W Deyoung St Ste 101
Marion, IL 62959-5896
Phone
(618) 998-7169
Fax
(618) 998-7533
NPI assigned
Jan 23, 2023
Last updated
Jan 26, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2023

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

Authorized official

Name
Kyle Dillman
Title
Secretary
Phone
(812) 450-7399

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363L00000X Primary
Occupational Health Clinical Nurse SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 364SX0106X

Addresses

Primary practice location

3331 W Deyoung St Ste 101
Marion, IL 62959-5896

Mailing address

3331 W Deyoung St Ste 101
Marion, IL 62959-5896
Phone (618) 998-7169

Other names 1

  • Deaconess IL Specialty Clinic Occupational Health Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Deaconess Illinois Specialty Clinic Inc19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1674432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674691200000",
    "number": "1154036259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3331 W DEYOUNG ST STE 101",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629595896",
            "telephone_number": "618-998-7169",
            "fax_number": "618-998-7533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3331 W DEYOUNG ST STE 101",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629595896",
            "telephone_number": "618-998-7169",
            "fax_number": "618-998-7533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEACONESS ILLINOIS SPECIALTY CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-23",
        "last_updated": "2023-01-26",
        "certification_date": "2023-01-26",
        "status": "A",
        "authorized_official_last_name": "DILLMAN",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "812-450-7399"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "364SX0106X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist, Occupational Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Deaconess IL Specialty Clinic Occupational Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Deaconess IL Specialty Clinic Occupational Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jan 26, 2023; 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.