Center for Advanced Medicine LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

CENTER FOR ADVANCED MEDICINE LLC

Doing business as

Performance Medical Clinic LLC

Practice address

5036 N Illinois St
Suite 1
Fairview Heights, IL 62208

Phone

(618) 671-6800

Fax

(619) 671-6604

NPI assigned

Jun 24, 2014

Last updated

Jul 18, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michael Thomas AmbroseNPI 1538398680

Title

Owner/Ceo

Phone

(618) 420-9360

Specialties & licenses 1

Addresses

Other names 1

• Performance Medical Clinic LLC Doing business as

Locations

Practitioners 1

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.

• Michael Ambrose, MD

  • Internal Medicine Physician
  • Mount Vernon, IL
  • NPI 1538398680
  Authorized official Same address or phone

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

{
    "created_epoch": "1403568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531872000000",
    "number": "1255746715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5036 N ILLINOIS ST",
            "address_2": "STE 1",
            "city": "FAIRVIEW HEIGHTS",
            "state": "IL",
            "postal_code": "622083411",
            "telephone_number": "618-671-6800",
            "fax_number": "618-671-6604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5036 N ILLINOIS ST",
            "address_2": "SUITE 1",
            "city": "FAIRVIEW HEIGHTS",
            "state": "IL",
            "postal_code": "62208",
            "telephone_number": "618-671-6800",
            "fax_number": "619-671-6604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR ADVANCED MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-24",
        "last_updated": "2018-07-18",
        "status": "A",
        "authorized_official_last_name": "AMBROSE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "618-420-9360"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Performance Medical Clinic LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Chester A Carothers Jr., L.C.S.W.
• Ciara Nicole Carter
• Madison L Castillo
• Center for Gastrointestinal Health
• Center for Gastrointestinal Health, SC
• Jill Nicole Ceretto, COTA/L
• Chestnut Health Systems, Inc.
• Earnestine Moore Chotkowski, REGISTERED NURSE

• Internal Medicine Physician in Fairview Heights, IL
• Providers in Fairview Heights, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2018; 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.