NPIMap

Organization Active NPI

PC Associates LLC

  • Internal Medicine Physician
  • O'Fallon, IL
National Provider Identifier
1235452855
Registry record updated Jul 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036053136 Issued in IL
Legal business name
PC ASSOCIATES LLC
Practice address
310 North Seven Hills Road
O'Fallon, IL 62269
Phone
(618) 624-6181
Fax
(618) 622-2593
NPI assigned
Mar 10, 2010
Last updated
Jul 29, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2014

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

Authorized official

Name
Mr. James B. Davis, FACHE, MBA, MHSA
Title
Executive Director
Phone
(618) 257-6301

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 036053136 IL Primary

Addresses

Primary practice location

310 North Seven Hills Road
O'Fallon, IL 62269

Mailing address

4500 Memorial Drive
Medical Affairs Office
Belleville, IL 62226
Phone (618) 257-4644

National Provider Directory

National Provider Directory

Locations

101 S Belt W
#Four
Belleville, IL 62220
Phone (618) 277-7700

4550 Memorial Dr
Ste 180
Belleville, IL 62226
Phone (618) 235-8282

4600 Memorial Dr
Ste 180
Belleville, IL 62226
Phone (618) 235-8282

830 Admiral Weinel Blvd
Ste 200
Columbia, IL 62236
Phone (618) 281-7373

220 Field Crossing Dr
Highland, IL 62249
Phone (618) 391-9132

673 E Saint Louis St
Nashville, IL 62263
Phone (618) 327-8119

3 Park Pl
Swansea, IL 62226
Phone (618) 222-9244

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1268179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406592000000",
    "number": "1235452855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 MEMORIAL DRIVE",
            "address_2": "MEDICAL AFFAIRS OFFICE",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "62226",
            "telephone_number": "618-257-4644",
            "fax_number": "618-257-6946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 NORTH SEVEN HILLS ROAD",
            "city": "O'FALLON",
            "state": "IL",
            "postal_code": "62269",
            "telephone_number": "618-624-6181",
            "fax_number": "618-622-2593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PC ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-10",
        "last_updated": "2014-07-29",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "618-257-6301",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "FACHE, MBA, MHSA"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036053136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in O'Fallon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2014; 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.