Eldorado Emergency Group PC
Organization Active NPI Emergency Medicine Physician · Eldorado, IL
NPI 1235868191 · NPPES record last updated Jun 7, 2022
Key facts
- NPI
- 1235868191
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- Legal business name
- ELDORADO EMERGENCY GROUP PC
- Practice address
- 1201 Pine St
Eldorado, IL 62930-1634 - Phone
- (618) 273-3361
- Fax
- (618) 273-2571
- NPI assigned
- Jun 7, 2022
- Organization subpart
- No
Authorized official
- Name
- Dr. Christopher P Lipsmeyer, MD
- Title
- Director
- Phone
- (337) 609-1221
Practitioners 26
-
Mike S Davenport, FNP
-
Brandon Cole Edwards, NP-C
-
Pak K Fung, M.D.
-
Constance M Henshaw, FNP-C
-
Gerald Wayne McClallen, D.O.
-
Mark Kiplagat Rotich, M.D.
-
Joshua Hastie, MD
-
Paul W. Koch, M.D.
-
Ravi B Masih, M.D.
-
Terry R Perkins, M.D.
-
Clinton Jay Mohr, M.D.
-
Stephen F Israel, MD
-
William Scott Boston, M.D.
-
Kristen L Ferguson, M.D.
-
Michael E Mandis, MD
-
Meghan A Mitchell, FNP
-
Susan E Sigler, FNP
-
Melissa Welge, DNP, FNP-C
-
Faisal Lala, D.O.
-
Nevine Mahmoud, MD, MS, MS
-
Melissa J Gauthier, PA C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220801002597 | IL | Part B Supplier - Clinic/Group Practice | 3678955028 |
Receives reassigned benefits from 25 practitioners Practice locations: Eldorado, IL |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician |
207P00000X | Yes | ||
| Internal Medicine Physician |
207R00000X | |||
| Physician Assistant |
363A00000X | |||
| Nurse Practitioner |
363L00000X |
Addresses
Primary practice location
1201 Pine St
Eldorado, IL 62930-1634
Mailing address
200 Corporate Blvd
Lafayette, LA 70508-3870
Phone (800) 893-9698
Other providers in Eldorado, IL
- Egyptian Public and Mental Health Department
- Egyptian Public and Mental Health Department
- Egyptian Public and Mental Health Department
- Egyptian Public and Mental Health Department
- Eldorado Community Unit School District #4
- Eldorado Rehab & Healthcare, LLC
- Nickie Evans
- Katherine Ewell
- Kimball Ewell
- Rebecca Farler
All providers in Eldorado, IL · Emergency Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 7, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.