Western Illinois Medical Group, LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

WESTERN ILLINOIS MEDICAL GROUP, LLC

Practice address

909 E Grant St
Macomb, IL 61455-3371

Phone

(309) 837-7546

Fax

(312) 674-7546

NPI assigned

Apr 4, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Xiaolu Li, M.D.

Title

Physician

Phone

(309) 837-7546

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

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

• Zhong Ye, M.D.

  • Dermatology Physician
  • Macomb, IL
  • NPI 1255406518
  Medicare reassignment NPD

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674000000000",
    "number": "1205958741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 E GRANT ST",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614553371",
            "telephone_number": "309-837-7546",
            "fax_number": "126-747-5463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 E GRANT ST",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614553371",
            "telephone_number": "309-837-7546",
            "fax_number": "312-674-7546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN ILLINOIS MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2023-01-18",
        "certification_date": "2023-01-18",
        "status": "A",
        "authorized_official_last_name": "LI",
        "authorized_official_first_name": "XIAOLU",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "309-837-7546",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036099467",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "039099467",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHEILD",
            "identifier": "05532018",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Corey T Welchlin, D.O.
• Wesley Village
• Wesley Village, Inc
• Wesley Village, Inc
• West Central Illinois Spec Ed
• Western Illinois Service Coordination
• Western Illinois Surgical Associates, S.C.
• Western Illinois University
• Western Illinois University Speech Language Hearing Clinic
• Ronald D. Wheeler, M.D.

• Dermatology Physician in Macomb, IL
• Providers in Macomb, IL by specialty
• Dermatology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.