Geriatric and Primary Care Services S C

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

036111926 Issued in IL

Legal business name

GERIATRIC AND PRIMARY CARE SERVICES S C

Practice address

1606 Castleberry Dr
Marion, IL 62959-1586

Phone

(618) 997-9519

Fax

(618) 993-0592

NPI assigned

Aug 12, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Gladstone A Tucker, MD

Title

Owner

Phone

(618) 542-6152

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Rose Y Grunert, FNP

  • Family Nurse Practitioner
  • Benton, IL
  • NPI 1649378001
  NPD (past)
• Ramesh M Patel, MD

  • Family Medicine Physician
  • Marion, IL
  • NPI 1821104258
  NPD (past)
• Robyn Dettmar, PA

  • Physician Assistant
  • Claremont, CA
  • NPI 1417951096
  NPD (past)

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

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343174400000",
    "number": "1174535900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 752",
            "city": "CONCORDIA",
            "state": "MO",
            "postal_code": "640200752",
            "telephone_number": "660-463-1365",
            "fax_number": "660-463-1367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1606 CASTLEBERRY DR",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629591586",
            "telephone_number": "618-997-9519",
            "fax_number": "618-993-0592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GERIATRIC AND PRIMARY CARE SERVICES S C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-12",
        "last_updated": "2012-07-25",
        "status": "A",
        "authorized_official_last_name": "TUCKER",
        "authorized_official_first_name": "GLADSTONE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-542-6152",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "IL",
            "license": "036111926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexandra Gauthier, BA
• Ted Gennerman, PH.D
• Richard Joseph George Jr., M.D.
• Shirley George, LCSW
• Alisha Gerald, ASED
• Amy Elizabeth Gerwe, M.D.
• Jeremy Paul Gerwe, M.D.
• Susan L. Gholson, MSW
• Jessica Gibbs
• Aline Gilbert-Johnson, MD

• Geriatric Medicine (Internal Medicine) Physician in Marion, IL
• Providers in Marion, IL by specialty
• Geriatric Medicine (Internal Medicine) Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2012; 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.